Counseling Considerations Research Articles

Cancer surveillance for transgender and gender diverse patients with Lynch syndrome: a practice resource of the Collaborative Group of the Americas on Inherited Gastrointestinal Cancer.

Transgender and gender diverse (TGD) populations with hereditary cancer syndromes face unique obstacles to identifying and obtaining appropriate cancer surveillance and risk-reducing procedures. There is a lack of care provider knowledge about TGD health management. Lynch syndrome (LS) is one of the most common hereditary cancer syndromes, affecting an estimated 1 in 279 individuals. There are no clinical guidelines specific for TGD individuals with LS, highlighting a need to improve the quality of care for this population. There is an urgent need for cancer surveillance recommendations for TGD patients. This commentary provides recommendations for cancer surveillance, risk-reducing strategies, and genetic counseling considerations for TGD patients with LS.

Part I: Interactive case: Menopause

Part I: Interactive case: Menopause

Expectations and Reality Regarding Teacher Personality: Perspectives of Indonesian Students Using Importance-Performance Analysis

The purpose of this study was to describe the personality of teachers in Indonesia using an analysis of students who aspire to continue their education in educational study programs in Indonesia. The research sample consisted of 1994 students, of which 668 were male and 1326 female students enrolled in several majors, such as science, social studies, language, religion, and others. Respondents were obtained through purposive sampling. Attributes and latent constructs were classified using importance-performance analysis (IPA). The results of the study indicate that there are three personality traits that need to be improved by teachers, namely being supportive, caring, and sensitive to problems. Male respondents identified seven personality traits on the priority scale that need to be improved. That is, teachers need to be communicative, broad-minded, diligent, calm, objective, authoritative, and up to date. Furthermore, female respondents indicated five personality items on the priority scale that need to be improved. That is, teachers need to be trained, communicative, diligent, responsive, and not careless. These findings can be used as input for teachers to be able to improve their personality competence. It can also become a reference for students to be able to ensure that they have a positive personality as one of the competences that prospective teachers must possess. This research forms the basis for initial considerations for counselors to provide guidance and counseling services, especially in career planning, for students who consider becoming educators as a future career.

PD40-10 THE IMPACT OF FRAILTY ON PERIOPERATIVE OUTCOMES IN PATIENTS UNDERGOING RADICAL NEPHRECTOMY

You have accessJournal of UrologyCME1 Apr 2023PD40-10 THE IMPACT OF FRAILTY ON PERIOPERATIVE OUTCOMES IN PATIENTS UNDERGOING RADICAL NEPHRECTOMY Rahul Dutta, Justin Refugia, Ethan Matz, Randy Casals, and Matvey Tsivian Rahul DuttaRahul Dutta More articles by this author , Justin RefugiaJustin Refugia More articles by this author , Ethan MatzEthan Matz More articles by this author , Randy CasalsRandy Casals More articles by this author , and Matvey TsivianMatvey Tsivian More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003345.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: As the geriatric population continues to grow, an increasing number of medically frail patients are developing renal masses that necessitate surgical intervention. These patients, however, are significantly more likely to suffer from adverse events following a variety of surgical procedures. We sought to better understand the relationship with frailty and postoperative complications after open (ORN) and laparoscopic (LRN) radical nephrectomy for renal masses. METHODS: The National Surgical Quality Improvement Program database was queried for ORN (CPT® 50230) and LRN (CPT® 50545) from 2015-2020. The modified 5-item frailty index (5-MFI) was calculated based on patient functional status and medical comorbidities (diabetes, congestive heart failure, chronic obstructive pulmonary disease, and hypertension requiring medication). Patients with a 5-MFI score ≥2 were considered medically frail. Associations with 30-day events were analyzed. RESULTS: A total of 6,324 ORN and 15,629 LRN were included, of which 22% and 24%, respectively, were considered frail by at 5-MFI score of ≥2. Increased age and body mass index (BMI) were significantly associated with frailty for both ORN and LRN (p<0.05). Upon multivariate analysis controlling for age and BMI in ORN, frailty was independently associated with minor (OR=1.17 [1.03-1.33], p=0.013) and major (OR=1.43 [1.16-1.77], p=0.001) postoperative complications. Both repeat operations (OR=1.56 [1.08-2.25], p=0.018) and readmissions (OR=1.39 [1.12-1.71], p=0.002) were also independently associated with frailty. Similarly for LRN, minor complications (OR=1.75 [1.56-1.98], p<0.001), major complications (OR=1.74 [1.45-2.08], p<0.001) and readmissions (OR=1.62 [1.39-1.90], p<0.001) were independently associated with frailty; reoperations (OR=1.10 [0.82-1.47], p=0.526) were not. CONCLUSIONS: Patients considered medically frail are more likely to suffer from 30-day postoperative complications, unplanned readmissions, and reoperations following radical nephrectomy. In the context of an aging population, frailty should be taken into consideration for counseling and postoperative management following radical nephrectomy. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1056 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rahul Dutta More articles by this author Justin Refugia More articles by this author Ethan Matz More articles by this author Randy Casals More articles by this author Matvey Tsivian More articles by this author Expand All Advertisement PDF downloadLoading ...

Which Concerns Deserve Consideration in Dietary Counseling of Patients Earning Low Incomes?

This commentary on a case considers when physicians offering health advice on diet has potential to undermine trust. If physicians fail to model behaviors for which they advocate, they could be targeted by media or have disputes with colleagues, which could further undermine trust. To better manage professional obligations to both individual patients and the public, this article proposes prioritizing interprofessional, community-engaged approaches to advocacy.

Intrauterine contraceptive discontinuation reasons among female trial participants living with HIV in Cape Town, South Africa: A qualitative analysis.

While young women in South Africa may navigate both HIV infection and pregnancy risks, intrauterine contraceptive (IUC) use is low. Though IUCs have low failure rates, concerns exist about whether the IUC is an appropriate method choice for women living with HIV (WLHIV). In this qualitative study, we explore WLHIVs' experiences of using IUC and reasons for discontinuation. This qualitative study included in-depth interviews (IDIs) with 17 WLHIV who electively discontinued their allocated IUC while participating in a randomized controlled trial comparing the safety of the levonorgestrel intrauterine system (LNG-IUS) and the copper intrauterine device (C-IUD) in Cape Town, South Africa. The transcripts were coded and emergent themes were grouped to examine women's experiences with IUC use and reasons for discontinuation, highlighting experiential differences between the two methods. Women's experience with the allocated IUC related most commonly to bleeding and/or abdominal pain just after insertion. Most C-IUD discontinuers, but only one LNG-IUS discontinuer, complained of pain and/or increased bleeding as the main reason for removal. Three women (two LNG-IUS, one C-IUD) requested removal because they desired pregnancy, while two others discontinued due to fears the IUC was exacerbating non-gynecologic conditions (hypertension, diabetes). Generally, women acknowledged advantages of IUC use and many expressed their desire to continue use if not for the side effects. In the South African context, IUC use for WLHIV should be promoted with specific counseling considerations. Both providers and potential users should receive specific information about potential menstrual-related side effects and countering common misperceptions to enable informed contraceptive decision-making.

The Ultimate Trauma: A Murdered Child Counseling Considerations

Nothing is more devastating to a family than the death of their child. A sudden death due to a violent crime such as murder including school shootings can be life-shattering. According to socially prescribed and predictable scripts, children are supposed to outlive their parents. When a child dies before the parent, the blueprint for one's life journey is backwards, leaving no prescribed plan to guide the family through life. When the death occurs as a result of murder, it is even more devastating. This article explores this backward script of a child dying before his or her parents because of murder and the resulting journey the family faces. It first examines the incidences of murdered children and then explores some possible barriers to the healing process. Next, the concept of scripts is explored, exploring different death scripts. The effect of a murdered child on the marital role, the parental role, and siblings is also presented. Psychological reactions are discussed and counseling considerations are presented. Counseling implications are considered throughout. This journey is demonstrated through the experiences of Cameron's family, Cameron was a 16-year-old adolescent who was murdered. This case history is fictitious and was developed to illustrate points in the paper. It is in no way related to any individual or family.

The effect of BMI and other factors on post-operative length of stay: A multivariable regression analysis of 860 patients undergoing total knee arthroplasty

BackgroundThere is a trend towards minimising length of stay (LOS) after total knee arthroplasty (TKA), as greater LOS is associated with poorer outcomes and higher costs. Patient factors known to influence LOS post-TKA include age and ASA grade. Evidence regarding the effect of body mass index (BMI) in particular is conflicting, with some studies finding that increased BMI predicts increased LOS, while others have found no relationship. Few previous studies, which have mostly been conducted outside the UK, have examined the effect of living alone or socioeconomic deprivation, which may be confounders. MethodsWe conducted a retrospective cohort study of 1031 consecutive primary TKAs performed between 1 April 2021 and 31 December 2021 in a single high-volume arthroplasty centre. A multivariable negative binomial regression model was performed for the 860 patients with complete data, using pre-operative (BMI, age, gender, ASA grade, smoking, ethnicity, socioeconomic deprivation, living arrangement, EQ5D quality of life score, and indication for surgery) and peri-operative variables (surgeon, surgical approach, tourniquet use, a.m./p.m operation, operation side, duration, and day of the week). ResultsMean LOS was 2.6 days. BMI and socioeconomic deprivation had no effect on LOS (P > 0.05). Increased LOS was associated with living alone, lower EQ5D, age and ASA grade (all P < 0.001), p.m. operation (P < 0.01), female gender and duration of surgery (P < 0.05). ConclusionBMI and socioeconomic status were not correlated with LOS after TKA. Living alone, which has not been previously reported and lower pre-operative EQ5D status were significant risk factors, which merit consideration in pre-operative planning and counselling.

“The Parallel Dialogue”: Parental experience of their role in the relationship with their child's counsellor/psychotherapist

AbstractThe parent–therapist relationship is a central consideration in child counselling and psychotherapy, particularly in private practice where parents are typically financially, emotionally and practically invested in the process. The relationship, which can be ambiguous and anxiety‐laden on both sides, has historically received scant attention in therapeutic discourse, leading to gaps in practitioner confidence and training. In this context, and seeking to centre parent voices, this study provides an interpretative phenomenological analysis of four mothers' experiences of their role in the relationship with their child's therapist. Key identified themes encompass parental expectation of involvement; the destabilising, disorienting nature of the relationship; the centrality of trust; and critical evaluations of value. Findings are discussed in relation to attachment theory and cultural expectations of parental responsibility. The study concludes that the relationship is a live and potent property with potential to impact the course of the intervention, and recommends that practitioners thoughtfully consider the potential benefits and drawbacks of meeting or frustrating parental involvement expectations.

Career Counselling Considerations for Mothers Returning to Work

Women transitioning back to work from motherhood face complex challenges, including changes in their self-concept, priorities, self-confidence, and career-related beliefs. To effectively support mothers contemplating workforce reentry, career counsellors must understand the unique interplay between their clients’ home, community, and previous work lives and its impact on their career development. This article integrates relevant concepts from the career development theories of Super, Krumboltz, and Social Cognitive Career Theory with current literature to inform career counselling interventions aimed at optimizing the reentry experiences of mothers returning to work.

P622: NIPS dilemma in the context of consanguinity: Considerations for counseling

P622: NIPS dilemma in the context of consanguinity: Considerations for counseling

Genetic counseling considerations in cerebral palsy.

Genome-wide sequencing (exome and whole genome) has transformed our ability to diagnose patients with suspected genetic disorders. Cerebral palsy (CP), although historically thought to be due to birth injury (perinatal hypoxia), represents a clinical spectrum of disorders, many of which have been attributed to a genetic cause. GWS has elucidated the underlying single gene cause for many patients with CP and has important implications for the customization of treatment, management, and genetic counseling. International guidelines recommend genetic counseling for all families considering genome-wide sequencing. Genetic counselors educate and support families and help them to make testing decisions based on their values. They can help families adapt to, and understand the implications of a genomic diagnosis. Here, we review advances in sequencing for CP, clinical features suggestive of a genetic etiology of CP, practice guidelines for GWS, and a practical approach to the genetic counseling of these families. This includes: the content to be addressed in pre-test and post-test genetic counseling sessions, the benefits of a establishing a genetic cause and importantly, the need for ongoing support.

ATM c.7570G>C is a high-risk allele for breast cancer.

ATM is generally described as a moderate-risk breast cancer susceptibility gene. However, some of ATM variants might encounter higher risk. ATM c.7570G>C, p.Ala2524Pro, (rs769142993) is a pathogenic Finnish founder variant causative for recessively inherited ataxia-telangiectasia. At cellular level, it has been reported to have a dominant-negative effect. ATM c.7570G>C has recurrently been described in Finnish breast cancer families and unselected case cohorts collected from different parts of the country, but the rarity of the allele (MAF 0.0002772 in Finns) and lack of confirming segregation analyses have prevented any conclusive risk estimates. Here, we describe seven families from genetic counseling units with ATM c.7570G>C variant showing co-segregation with breast cancer. Further analysis of the unselected breast cancer cohort from Northern Finland (n=1822), a geographical region previously indicated to have enrichment of the variant, demonstrated that c.7570G>C significantly associates with breast cancer, and the risk is estimated as high (odds ratio [OR]=8.5, 95% confidence interval [CI]=1.04-62.46, P=.018). Altogether, these results place ATM c.7570G>C variant among the high-risk alleles for breast cancer, which should be taken into consideration in genetic counseling.

EVIDENCE OF THE NEED FOR INCREASING GENETICS EDUCATION AND SUPPORT FOR GAMETE DONOR RECIPIENTS: RECOMMENDATIONS FOR REPRODUCTIVE PROVIDERS

Genetic screening of gamete donors and tracking of health issues in donor-conceived offspring are performed to avoid transmission of significant health issues to donor-conceived individuals. As degree of risk is subjective, donors need not be excluded from a donor program; however, reproductive risk information will continue to grow in complexity due to advances in genetic testing and understanding of inherited susceptibilities. This study details the types of health information available on gamete donors at a sperm bank and the counseling considerations for the healthcare providers of the intended parents.

Opinion: Patient reported motivations for seeking stem cell therapy and considerations for counseling.

Stem cell therapies occupy a unique place in the American public's consciousness which has led to excessive enthusiasm over their potential to cure orthopedic conditions. Much has been written about direct-to-consumer marketing of cell therapies for a myriad of medical conditions. Far less has been studied on the attitudes that drive many patients to seek stem cell and orthobiologic therapies for musculoskeletal conditions. Previously published research on patient motivations for seeking stem cell therapy to treat orthopedic maladies such as osteoarthritis and chronic tendinopathies has shown that some patients were motivated by factors not supported by current medical evidence. These differing responses strongly suggest the need for patient-centered counseling to address misinformation about stem cell therapies for musculoskeletal conditions and increase health literacy about outcomes of orthobiologics.

Incidence of self-reported pelvic pain and risk factors for pain 1 year after benign hysterectomy: A register study from the Swedish National Quality Registry for Gynecological Surgery.

The primary aim of this study was to determine the incidence of patient-reported pain 1 year after hysterectomy for benign gynecological conditions in relation to occurrence of preoperative pain. The secondary aim was to analyze clinical risk factors for pain 1 year after the hysterectomy in women with and without preoperatively reported pelvic/lower abdominal pain. This was a historical cohort study using data from the Swedish National Quality Registry for Gynecological Surgery on 16 694 benign hysterectomies. Data were analyzed using multivariable logistic regression models. One year after surgery, 22.4% of women with preoperative pain reported pelvic pain and 7.8% reported de novo pelvic pain. For those with preoperative pain younger age (adjusted odds ratio [aOR] 1.75, 95% confidence interval [CI] 1.38-2.23 and aOR 1.21, 95% CI 1.10-1.34 for women aged <35 and 35-44 years, respectively), not being gainfully employed (aOR 1.43, 95% CI 1.26-1.63), pelvic pain as the main symptom leading to hysterectomy (aOR 1.51, 95% CI 1.19-1.90), endometriosis (aOR 1.18, 95% CI 1.06-1.31), and laparoscopic hysterectomy (aOR 1.30, 95% CI 1.07-1.58), were clinically relevant independent risk factors for pelvic/lower abdominal pain 1 year after surgery, as were postoperative complications within 8 weeks after discharge. Meanwhile, clinically relevant independent risk factors for reporting de novo pain 1 year after surgery were younger age (aOR 2.05, 95% CI 1.08-3.86 and aOR 1.29, 95% CI 1.04-1.60 for women aged <35 and 35-44 years, respectively), and postoperative complications within 8 weeks after discharge. The incidence of pelvic pain and de novo pain 1 year after hysterectomy was relatively high. Women with and without reported preoperative pelvic/lower abdominal pain represented clinically different populations. The risk factors for pelvic pain seemed to differ in these two populations. The differences in risk factors couldbe taken into consideration in the preoperative counseling and in the decision-making concerning method of hysterectomy, provided that large well-designed studies confirm these risk factors.

Assessment Of Sleep Quality By The Athlete Sleep Screening Questionnaire In Chinese Collegiate Athletes

Purpose: This study aimed to characterize sleep quality and to explore the factors that are associated with the severity of sleep difficulty among Chinese collegiate athletes. Methods: Sleep quality and associated factors were assessed by the Athlete Sleep Screening Questionnaire (ASSQ) in college athletes (n = 395, 73.6% response rate, aged 18 to 32 years, 47.6% female, 22.5% were master level, 47.6% national level and 29.9% second level in 15 different sports events). A sleep difficulty score (SDS) and level of sleep problem (0-4, none; 5-7, mild; 8-10, moderate; 11-17, severe) were used to classify participants. In addition, sports-related information such as sports events and training years were collected. Categorical variables were analyzed by Chi-squared (ꭓ2) or fisher’s exact test. An ordinal logistic regression analysis was used to explore factors with poor sleep (SDS > 8). Results: Approximately 14.2% of participants were found to have moderate to severe sleep problem (SDS > 8). When athletes travelled to participate in sports competitions, those who have experienced sleep disturbance were more diagnosed in the moderate-to-severe problem category than those without sleep disturbance (11.4% Vs. 2.8%, ꭓ2, 27.5; P < 0.001). While athletes who experienced daytime dysfunction when traveling fell more into the moderate-to-severe sleep problem category than athletes without daytime dysfunction (7.6% Vs. 6.6%, ꭓ2, 20.7; P < 0.001). No significant difference was found in SDS category between gender, sports level and sports events (All P > 0.05). Athletes with evening chronotype were more likely to report worse sleep compared to athletes with morning chronotype (OR, 2.25; 95%CI, 1.44 - 3.52; P < 0.001). For each additional year of age, there was an increase in odds ratio for poor sleep quality (OR1.15; 95% CI, 1.04 - 1.26; P = 0.004). However, increasing each additional year of training reduced the odds ratio for poor sleep quality (OR,0.95; 95% CI, 0.91 - 0.99; P = 0.044). Conclusion: To improve sleep health in collegiate athletes, chronotype, travel-related issues, age and training years should be taken into consideration in sleep counseling.

Multisite assessment of the impact of cell-free DNA-based screening for rare autosomal aneuploidies on pregnancy management and outcomes.

Cell-free (cf) DNA screening is a noninvasive prenatal screening approach that is typically used to screen for common fetal trisomies, with optional screening for sex chromosomal aneuploidies and fetal sex. Genome-wide cfDNA screening can screen for a wide variety of additional anomalies, including rare autosomal aneuploidies (RAAs) and copy number variants. Here, we describe a multi-cohort, global retrospective study that looked at the clinical outcomes of cases with a high-risk cfDNA screening result for a RAA. Our study cohort included a total of 109 cases from five different sites, with diagnostic outcome information available for 68% (74/109) of patients. Based on confirmatory diagnostic testing, we found a concordance rate of 20.3% for presence of a RAA (15/74) in our study population. Pregnancy outcome was also available for 77% (84/109) of cases in our cohort. Many of the patients experienced adverse pregnancy outcomes, including intrauterine fetal demise, fetal growth restriction, and preterm birth. These adverse outcomes were observed both in patients with fetal or placental confirmation of the presence of a RAA, as well as patients that did not undergo fetal and/or placental diagnostic testing. In addition, we have proposed some suggestions for pregnancy management and counseling considerations for situations where a RAA is noted on a cfDNA screen. In conclusion, our study has shown that genome-wide cfDNA screening for the presence of rare autosomal aneuploidies can be beneficial for both patients and their healthcare practitioners. This can provide a possible explanation for an adverse pregnancy outcome or result in a change in pregnancy management, such as increased monitoring for adverse outcomes.

Comparison of survival between unilocular cystic and purely solid renal cell carcinoma

To evaluate clinicopathological features and survival outcomes of unilocular cystic renal cell carcinoma (ucRCC) compared with purely solid renal cell carcinoma (sRCC), and to evaluate the oncologic aggressiveness of ucRCC. The relevant data of 957 patients with sporadic unilateral renal cell carcinoma (RCC) underwent surgical treatment in 2 institutions from Jan 2014 to Oct 2018 were obtained. We excluded multilocular cystic renal neoplasm of low malignant potential (MCRNLMP), RCC with multilocular cysts and necrotic RCC. 74 ucRCCs were identified by pathology reports. We performed propensity score matching (PSM) and eventually selected 144 sRCCs. The clinicopathological features and survival outcomes were compared properly. After PSM, age, BMI, Charlson Comorbidity Index, and postoperative Chronic Kidney Disease grade were not significantly different. Both overall survival and progression-free survival of ucRCC were significantly better than sRCC by the log-rank test. Twenty-five cases of sRCCs were in the pT3 or pT4 stage, while no pT3 or pT4 tumors were found in ucRCCs. Fuhrman grade and lymphatic metastasis were found to be significant prognostic factors for the overall survival of ucRCC. Unilocular cystic RCC has a lower Fuhrman grade and pathological stage and a better prognosis compared with solid RCC. Patients with ucRCC still probably have lymphatic metastasis at surgery and may have postoperative metastasis, which is different from MCRNLMP. We recommend that the diagnosis of ucRCC should be reflected in pathology report. Different subtype of cystic RCC should be taken into consideration in counseling and management.

Women's thoughts on receiving and sharing genetic information: Considerations for genetic counseling.

Indications for genetic testing for inherited cancer syndromes are expanding both in the academic and the community setting. However, only a fraction of individuals who are candidates for testing pursue this option. Therefore, it is important to understand those factors that impact the uptake of genetic testing in individuals affected and unaffected with cancer. A successful translation of genomic risk stratification into clinical care will require that providers of this information are aware of the attitudes, perceived risks and benefits, and concerns of individuals who will be considering testing. The purpose of this study was to assess beliefs, attitudes and preferences for genetic risk information, by personal characteristics of women affected and unaffected by breast cancer enrolled in the Breast Cancer Family Registry Cohort. Data for this analysis came from eight survey questions, which asked participants (N=9,048, 100% female) about their opinions regarding genetic information. Women reported that conveying the accuracy of the test was important and were interested in information related to personal level of risk, finding out about diseases that could be treated, and information that could be helpful to their families. Young women were most interested in how their own health needs might be impacted by genetic test results, while older women were more interested in how genetic information would benefit other members of the family. Interest in how the genetic test was performed was highest among Asian and Hispanic women. Women affected with breast cancer were more likely to report feeling sad about possibly passing down a breast cancer gene, while unaffected women were more uncertain about their future risk of cancer. The variety of informational needs identified has implications for how genetic counselors can tailor communication to individuals considering genetic testing.