Family stories and the use of heuristics: women from suspected hereditary breast and ovarian cancer (HBOC) families
Family stories and the use of heuristics: women from suspected hereditary breast and ovarian cancer (HBOC) families
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DOI：
10.1046/j.1467-9566.2003.00372.x
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发表时间：
2003-11-01
影响因子：
2.9
通讯作者：
Eeles, R
中科院分区：
文献类型：
--
作者：
Kenen, R;Ardern-Jones, A;Eeles, R
医学实践将越来越多地成为家庭医学，而不是传统的医生/病人二元关系，特别是涉及遗传条件的情况下。本研究探讨了来自疑似遗传性乳腺癌和卵巢癌（HBOC）家庭寻求癌症遗传风险咨询的客户如何受到家庭故事和使用推理（用于理解复杂信息的推理捷径）的影响，并在解释和应用他们收到的遗传信息，并建议遗传咨询师可以将家庭背景整合到他们传统的咨询实践中。我们进行了一项探索性的，定性的研究，在一个主要的临床和研究癌症中心在英国从2000年1月至6月，由医院的临床研究和伦理委员会审查。21个半结构化的，深入的采访进行了有目的的样本的妇女来癌症遗传学诊所的第一次，辅以5个月的临床观察，每周诊所。除了许多基于家族中癌症数量和结果的家庭故事外，我们还注意到：（1）故事片段，（2）秘密故事，（3）新兴解释和（4）误解。我们没有发现广泛的代际家庭神话。这些女性在解释她们的乳腺癌/卵巢癌风险时使用了三个主要的理论：（1）代表性，（2）可用性和（3）控制错觉，以及卡尼曼所说的峰和结束规则。最近的心理学研究表明，控制错觉可能对身心健康都有积极的影响。这可能会给遗传咨询师带来一个未来的伦理问题，即如何平衡积极幻想的好处与风险的统计概率。
The practice of medicine will increasingly be medicine of the family rather than the traditional physician/patient dyad, especially where a genetic condition is involved. This study explores how clients from suspected hereditary breast and ovarian cancer (HBOC) families seeking cancer genetics risk counselling are influenced by family stories and the use of heuristics (inferential shortcuts used to make sense of complicated Information) in interpreting and applying genetic information they receive, and suggests ways in which genetic counsellors can Integrate family context into their traditional counselling practices. We conducted an exploratory, qualitative study at a major clinical and research cancer centre in the United Kingdom from January to June 2000 which was reviewed by the hospital clinical research and ethics committees. Twenty-one semi-structured, in-depth interviews were conducted using a purposive sample of women coming to the cancer genetics clinic for the first time, supplemented by five months of clinical observation at weekly clinics. In addition to many family stories based on the number and outcomes of the cancers in their families, we noted: ( 1) fragments of stories, (2) Secret stories, (3) emerging explanations and (4) misconceptions. We did not find widespread intergenerational family myths. The women used three main heuristics in interpreting their breast/ovarian cancer risk: ( 1) representativeness, (2) availability and (3) illusion of control, as well as what Kahneman refers to as the Peak and End rule. Recent psychological research indicates that illusions of control may have positive affects on both physical and mental health. This may pose a future ethical issue for genetic counsellors in determining how to balance the benefit of positive illusions with the delivery of statistical probabilities of risk.