Psychological issues in genetic testing for inherited cardiovascular diseases

Circulation: Cardiovascular Genetics

Volumn 4, Issue 1, 2011, Pages 81-90

  Aatre, Rajani D ^a   Day, Sharlene M ^a  

^a UNIVERSITY OF MICHIGAN MEDICAL SCHOOL   (United States)

Author keywords

Arrhythmia; Arrhythmogenic right ventricular cardiomyopathy; Cardiomyopathy; Genetics; Hypertrophic cardiomyopathy; Long QT syndrome

Indexed keywords

ALLELE; AORTA DISEASE; ARTICLE; CARDIOVASCULAR DISEASE; DEFIBRILLATOR; FAMILIAL HYPERCHOLESTEROLEMIA; GENE MUTATION; GENETIC DISORDER; GENETIC SCREENING; HUMAN; HYPERTROPHIC CARDIOMYOPATHY; LONG QT SYNDROME; MARFAN SYNDROME; PHENOTYPE; PRIORITY JOURNAL; PSYCHOLOGICAL ASPECT; QUALITY OF LIFE;

CARDIOVASCULAR DISEASES; CHILD; CONFIDENTIALITY; DUTY TO WARN; GENETIC COUNSELING; GENETIC TESTING; HEALTH PLANNING GUIDELINES; HUMANS; INHERITANCE PATTERNS; PREJUDICE; RISK FACTORS;

EID: 79952798922     PISSN: 1942325X     EISSN: 19423268     Source Type: Journal    
DOI: 10.1161/CIRCGENETICS.110.957365     Document Type: Article

References (83)

1. Resta R, Biesecker BB, Bennett RL, Blum S, Hahn SE, Strecker MN, Williams JL. A new definition of genetic counseling: National Society of Genetic Counselors' Task Force Report. J Genet Couns. 2006;15:77-83. (Pubitemid 43876101)
2. Caleshu C, Day S, Rehm HL, Baxter S. Use and interpretation of genetic tests in cardiovascular genetics. Heart. 2010;96:1669-1675.
3. Judge DP, Dietz HC. Marfan's syndrome. Lancet. 2005;366:1965-1976. (Pubitemid 41713988)
4. Rantamaki T, Kaitila I, Syvanen AC, Lukka M, Peltonen L. Recurrence of Marfan syndrome as a result of parental germ-line mosaicism for an fbn1 mutation. Am J Hum Genet. 1999;64:993-1001. (Pubitemid 30463030)
5. Hershberger RE, Lindenfeld J, Mestroni L, Seidman CE, Taylor MR, Towbin JA. Genetic evaluation of cardiomyopathy: a Heart Failure Society of America practice guideline. J Card Fail. 2009;15:83-97.
6. Zipes DP, Camm AJ, Borggrefe M, Buxton AE, Chaitman B, Fromer M, Gregoratos G, Klein G, Moss AJ, Myerburg RJ, Priori SG, Quinones MA, Roden DM, Silka MJ, Tracy C, Smith SC Jr, Jacobs AK, Adams CD, Antman EM, Anderson JL, Hunt SA, Halperin JL, Nishimura R, Ornato JP, Page RL, Riegel B, Blanc JJ, Budaj A, Dean V, Deckers JW, Despres C, Dickstein K, Lekakis J, McGregor K, Metra M, Morais J, Osterspey A, Tamargo JL, Zamorano JL. ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (writing committee to develop guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation. 2006;114:e385-e484.
7. Ashida S, Koehly LM, Roberts JS, Chen CA, Hiraki S, Green RC. The role of disease perceptions and results sharing in psychological adaptation after genetic susceptibility testing: the reveal study. Eur J Hum Genet. 2010;18:1296-1301.
8. Cox S, O'Donoghue AC, McKenna WJ, Steptoe A. Health related quality of life and psychological wellbeing in patients with hypertrophic cardiomyopathy. Heart. 1997;78:182-187. (Pubitemid 27404956)
9. Carroll DL, Hamilton GA, McGovern BA. Changes in health status and quality of life and the impact of uncertainty in patients who survive life-threatening arrhythmias. Heart Lung. 1999;28:251-260. (Pubitemid 29337243)
10. Friedmann E, Thomas SA, Inguito P, Kao CW, Metcalf M, Kelley FJ, Gottlieb SS. Quality of life and psychological status of patients with implantable cardioverter defibrillators. J Interv Card Electrophysiol. 2006;17:65-72. (Pubitemid 46295285)
11. Hamang A, Eide GE, Nordin K, Rokne B, Bjorvatn C, Oyen N. Health status in patients at risk of inherited arrhythmias and sudden unexpected death compared to the general population. BMC Med Genet. 2010;11:27.
12. Jacq F, Foulldrin G, Savoure A, Anselme F, Baguelin-Pinaud A, Cribier A, Thibaut F. A comparison of anxiety, depression and quality of life between device shock and nonshock groups in implantable cardioverter defibrillator recipients. Gen Hosp Psychiatry. 2009;31:266-273.
13. Pedersen SS, Vandenbroek K, Vandenberg M, Theuns DA. Shock as a determinant of poor patient-centered outcomes in implantable cardioverter defibrillator patients: is there more to it than meets the eye? Pacing Clin Electrophysiol. 2010, July 21 [Epub ahead of print].
14. KC VDB, Habibovic M, Pedersen SS. Review: Emotional distress in partners of patients with an implantable cardioverter defibrillator: a systematic review and recommendations for future research. Pacing Clin Electrophysiol. 2010;33:1442-1450.
15. Sears SF, Matchett M, Conti JB. Effective management of ICD patient psychosocial issues and patient critical events. J Cardiovasc Electrophysiol. 2009;20:1297-1304.
16. Biesecker BB, Erby L. Adaptation to living with a genetic condition or risk: a mini-review. Clin Genet. 2008;74:401-407.
17. Ingles J, Lind JM, Phongsavan P, Semsarian C. Psychosocial impact of specialized cardiac genetic clinics for hypertrophic cardiomyopathy. Genet Med. 2008;10:117-120. (Pubitemid 351271723)
18. Christiaans I, van Langen IM, Birnie E, Bonsel GJ, Wilde AA, Smets EM. Genetic counseling and cardiac care in predictively tested hypertrophic cardiomyopathy mutation carriers: the patients' perspective. Am J Med Genet A. 2009;149A:1444-1451.
19. Djurdjinovic L. Psychosocial counseling. In: Baker DL, Schuette JL, Uhlmann WR, eds. A Guide to Genetic Counseling. Wiley-Liss: Hoboken, NJ, 1998:127-170.
20. Maron BJ. Hypertrophic cardiomyopathy. Lancet. 1997;350:127-133. (Pubitemid 27313649)
21. Hershberger RE, Cowan J, Morales A, Siegfried JD. Progress with genetic cardiomyopathies: Screening, counseling, and testing in dilated, hypertrophic, and arrhythmogenic right ventricular dysplasia/cardiomyopathy. Circ Heart Fail. 2009;2:253-261.
22. Van Driest SL, Ommen SR, Tajik AJ, Gersh BJ, Ackerman MJ. Yield of genetic testing in hypertrophic cardiomyopathy. Mayo Clin Proc. 2005; 80:739-744. (Pubitemid 40770360)
23. Girolami F, Ho CY, Semsarian C, Baldi M, Will ML, Baldini K, Torricelli F, Yeates L, Cecchi F, Ackerman MJ, Olivotto I. Clinical features and outcome of hypertrophic cardiomyopathy associated with triple sarcomere protein gene mutations. J Am Coll Cardiol. 2010;55:1444-1453.
24. Ingles J, Doolan A, Chiu C, Seidman J, Seidman C, Semsarian C. Compound and double mutations in patients with hypertrophic cardiomyopathy: implications for genetic testing and counselling. J Med Genet. 2005;42:e59.
25. Kelly M, Semsarian C. Multiple mutations in genetic cardiovascular disease: a marker of disease severity? Circ Cardiovasc Genet. 2009;2: 182-190.
26. Olivotto I, Girolami F, Ackerman MJ, Nistri S, Bos JM, Zachara E, Ommen SR, Theis JL, Vaubel RA, Re F, Armentano C, Poggesi C, Torricelli F, Cecchi F. Myofilament protein gene mutation screening and outcome of patients with hypertrophic cardiomyopathy. Mayo Clinic Proc. 2008;83:630-638. (Pubitemid 351810562)
27. Codd MB, Sugrue DD, Gersh BJ, Melton LJ III. Epidemiology of idiopathic dilated and hypertrophic cardiomyopathy: a population-based study in Olmsted County, Minnesota, 1975-1984. Circulation. 1989;80: 564-572. (Pubitemid 19231390)
28. Hershberger RE, Norton N, Morales A, Li D, Siegfried JD, Gonzalez- Quintana J. Coding sequence rare variants identified in mybpc3, myh6, tpm1, tnnc1, and tnni3 from 312 patients with familial or idiopathic dilated cardiomyopathy. Circ Cardiovasc Genet. 2010;3:155-161.
29. Fowler SJ, Napolitano C, Priori SG. The genetics of cardiomyopathy: genotyping and genetic counseling. Curr Treat Options Cardiovasc Med. 2009;11:433-446.
30. Taylor MR, Fain PR, Sinagra G, Robinson ML, Robertson AD, Carniel E, Di Lenarda A, Bohlmeyer TJ, Ferguson DA, Brodsky GL, Boucek MM, Lascor J, Moss AC, Li WL, Stetler GL, Muntoni F, Bristow MR, Mestroni L. Natural history of dilated cardiomyopathy due to lamin a/c gene mutations. J Am Coll Cardiol. 2003;41:771-780. (Pubitemid 36308384)
31. Peters S, Trummel M, Meyners W. Prevalence of right ventricular dysplasia-cardiomyopathy in a non-referral hospital. Int J Cardiol. 2004; 97:499-501. (Pubitemid 39550701)
32. Corrado D, Basso C, Thiene G, McKenna WJ, Davies MJ, Fontaliran F, Nava A, Silvestri F, Blomstrom-Lundqvist C, Wlodarska EK, Fontaine G, Camerini F. Spectrum of clinicopathologic manifestations of arrhythmogenic right ventricular cardiomyopathy/dysplasia: a multicenter study. J Am Coll Cardiol. 1997;30:1512-1520. (Pubitemid 27486470)
33. den Haan AD, Tan BY, Zikusoka MN, Llado LI, Jain R, Daly A, Tichnell C, James C, Amat-Alarcon N, Abraham T, Russell SD, Bluemke DA, Calkins H, Dalal D, Judge DP. Comprehensive desmosome mutation analysis in North Americans with arrhythmogenic right ventricular dysplasia/cardiomyopathy. Circ Cardiovasc Genet. 2009;2:428-435.
34. Dalal D, Molin LH, Piccini J, Tichnell C, James C, Bomma C, Prakasa K, Towbin JA, Marcus FI, Spevak PJ, Bluemke DA, Abraham T, Russell SD, Calkins H, Judge DP. Clinical features of arrhythmogenic right ventricular dysplasia/cardiomyopathy associated with mutations in plakophilin-2. Circulation. 2006;113:1641-1649.
35. Sen-Chowdhry S, Syrris P, Ward D, Asimaki A, Sevdalis E, McKenna WJ. Clinical and genetic characterization of families with arrhythmogenic right ventricular dysplasia/cardiomyopathy provides novel insights into patterns of disease expression. Circulation. 2007;115:1710-1720. (Pubitemid 46648607)
36. Xu T, Yang Z, Vatta M, Rampazzo A, Beffagna G, Pilichou K, Scherer SE, Saffitz J, Kravitz J, Zareba W, Danieli GA, Lorenzon A, Nava A, Bauce B, Thiene G, Basso C, Calkins H, Gear K, Marcus F, Towbin JA. Compound and digenic heterozygosity contributes to arrhythmogenic right ventricular cardiomyopathy. J Am Coll Cardiol. 2010;55:587-597.
37. Schwartz PJ, Stramba-Badiale M, Crotti L, Pedrazzini M, Besana A, Bosi G, Gabbarini F, Goulene K, Insolia R, Mannarino S, Mosca F, Nespoli L, Rimini A, Rosati E, Salice P, Spazzolini C. Prevalence of the congenital long-qt syndrome. Circulation. 2009;120:1761-1767.
38. Shimizu W. The long QT syndrome: therapeutic implications of a genetic diagnosis. Cardiovasc Res. 2005;67:347-356. (Pubitemid 41019544)
39. Schwartz PJ. The congenital long qt syndromes from genotype to phenotype: clinical implications. J Intern Med. 2006;259:39-47.
40. Schwartz PJ, Priori SG, Spazzolini C, Moss AJ, Vincent GM, Napolitano C, Denjoy I, Guicheney P, Breithardt G, Keating MT, Towbin JA, Beggs AH, Brink P, Wilde AA, Toivonen L, Zareba W, Robinson JL, Timothy KW, Corfield V, Wattanasirichaigoon D, Corbett C, Haverkamp W, Schulze-Bahr E, Lehmann MH, Schwartz K, Coumel P, Bloise R. Genotype-phenotype correlation in the long-qt syndrome: gene-specific triggers for life-threatening arrhythmias. Circulation. 2001;103:89-95. (Pubitemid 32050441)
41. Itoh H, Shimizu W, Hayashi K, Yamagata K, Sakaguchi T, Ohno S, Makiyama T, Akao M, Ai T, Noda T, Miyazaki A, Miyamoto Y, Yamagishi M, Kamakura S, Horie M. Long QT syndrome with compound mutations is associated with a more severe phenotype: a Japanese multicenter study. Heart Rhythm. 2010;7:1411-1418.
42. Ramirez F, Dietz HC. Marfan syndrome: from molecular pathogenesis to clinical treatment. Curr Opin Genet Dev. 2007;17:252-258. (Pubitemid 46843550)
43. Detaint D, Faivre L, Collod-Beroud G, Child AH, Loeys BL, Binquet C, Gautier E, Arbustini E, Mayer K, Arslan-Kirchner M, Stheneur C, Halliday D, Beroud C, Bonithon-Kopp C, Claustres M, Plauchu H, Robinson PN, Kiotsekoglou A, De Backer J, Ades L, Francke U, De Paepe A, Boileau C, Jondeau G. Cardiovascular manifestations in men and women carrying a fbn1 mutation. Eur Heart J. 2010;31:2223-2229.
44. Varret M, Abifadel M, Rabes JP, Boileau C. Genetic heterogeneity of autosomal dominant hypercholesterolemia. Clin Genet. 2008;73:1-13. (Pubitemid 350263516)
45. Taylor A, Wang D, Patel K, Whittall R, Wood G, Farrer M, Neely RD, Fairgrieve S, Nair D, Barbir M, Jones JL, Egan S, Everdale R, Lolin Y, Hughes E, Cooper JA, Hadfield SG, Norbury G, Humphries SE. Mutation detection rate and spectrum in familial hypercholesterolaemia patients in the UK pilot cascade project. Clin Genet. 2009;77:97-99.
46. Marais AD, Blom DJ, Firth JC. Statins in homozygous familial hypercholesterolemia. Curr Atheroscler Rep. 2002;4:19-25.
47. Choh SA, Choh NA, Rasool A, Yousuf R, Qureshi U. Homozygous familial hypercholesterolemia. J Pediatr Endocrinol Metab. 2009;22: 573-575.
48. Cameron LD, Muller C. Psychosocial aspects of genetic testing. Curr Opin Psychiatry. 2009;22:218-223.
49. Marteau T, Senior V, Humphries SE, Bobrow M, Cranston T, Crook MA, Day L, Fernandez M, Horne R, Iversen A, Jackson Z, Lynas J, Middleton-Price H, Savine R, Sikorski J, Watson M, Weinman J, Wierzbicki AS, Wray R. Psychological impact of genetic testing for familial hypercholesterolemia within a previously aware population: a randomized controlled trial. Am J Med Genet. 2004;128A:285-293. (Pubitemid 38849898)
50. O'Neill SC, Rini C, Goldsmith RE, Valdimarsdottir H, Cohen LH, Schwartz MD. Distress among women receiving uninformative brca1/2 results: 12-month outcomes. Psychooncology. 2009;18:1088-1096.
51. Vos J, Otten W, van Asperen C, Jansen A, Menko F, Tibben A. The counsellees' view of an unclassified variant in brca1/2: recall, interpretation, and impact on life. Psychooncology. 2008;17:822-830.
52. Christiaans I, Birnie E, Bonsel GJ, Wilde AA, van Langen IM. Uptake of genetic counselling and predictive DNA testing in hypertrophic cardiomyopathy. Eur J Hum Genet. 2008;16:1201-1207.
53. Biesecker BB. Psychological issues in cancer genetics. Semin Oncol Nurs. 1997;13:129-134.
54. Christiaans I, van Langen IM, Birnie E, Bonsel GJ, Wilde AA, Smets EM. Quality of life and psychological distress in hypertrophic cardiomyopathy mutation carriers: a cross-sectional cohort study. Am J Med Genet A. 2009;149A:602-612.
55. Hendriks KS, Hendriks MM, Birnie E, Grosfeld FJ, Wilde AA, van den Bout J, Smets EM, van Tintelen JP, ten Kroode HF, van Langen IM. Familial disease with a risk of sudden death: a longitudinal study of the psychological consequences of predictive testing for long qt syndrome. Heart Rhythm. 2008;5:719-724.
56. Broadstock M, Michie S, Marteau T. Psychological consequences of predictive genetic testing: a systematic review. Eur J Hum Genet. 2000; 8:731-738.
57. Butow PN, Lobb EA, Meiser B, Barratt A, Tucker KM. Psychological outcomes and risk perception after genetic testing and counselling in breast cancer: a systematic review. Med J Aust. 2003;178:77-81. (Pubitemid 36187626)
58. Lammens CR, Aaronson NK, Wagner A, Sijmons RH, Ausems MG, Vriends AH, Ruijs MW, van Os TA, Spruijt L, Gomez Garcia EB, Kluijt I, Nagtegaal T, Verhoef S, Bleiker EM. Genetic testing in Li-Fraumeni syndrome: uptake and psychosocial consequences. J Clin Oncol. 2010; 28:3008-3014.
59. Keller M, Jost R, Haunstetter CM, Kienle P, Knaebel HP, Gebert J, Sutter C, Knebel-Doeberitz M, Cremer F, Mazitschek U. Comprehensive genetic counseling for families at risk for HNPCC: impact on distress and perceptions. Genet Test. 2002;6:291-302. (Pubitemid 36020053)
60. Bleiker EM, Menko FH, Kluijt I, Taal BG, Gerritsma MA, Wever LD, Aaronson NK. Colorectal cancer in the family: psychosocial distress and social issues in the years following genetic counselling. Hered Cancer Clin Pract. 2007;5:59-66. (Pubitemid 47067605)
61. Prevost C, Veillette S, Perron M, Laberge C, Tremblay C, Auclair J, Villeneuve J, Tremblay M, Mathieu J. Psychosocial impact of predictive testing for myotonic dystrophy type 1. Am J Med Genet A. 2004;126A: 68-77. (Pubitemid 38436474)
62. Tibben A. Predictive testing for Huntington's disease. Brain Res Bull. 2007;72:165-171. (Pubitemid 46367464)
63. Duncan RE. Predictive genetic testing in young people: when is it appropriate? J Paediatr Child Health. 2004;40:593-595. (Pubitemid 39524183)
64. Wertz DC, Fanos JH, Reilly PR. Genetic testing for children and adolescents: who decides? JAMA. 1994;272:875-881.
65. Wilfond BS. Points to consider: ethical, legal, and psychosocial implications of genetic testing in children and adolescents: American Society of Human Genetics Board of Directors, American College of Medical Genetics Board of Directors. Am J Hum Genet. 1995;57:1233-1241.
66. Borry P, Evers-Kiebooms G, Cornel MC, Clarke A, Dierickx K. Genetic testing in asymptomatic minors: background considerations towards ESHG recommendations. Eur J Hum Genet. 2009;17:711-719.
67. Christiaans I, Lekanne dit Deprez RH, van Langen IM, Wilde AA. Ventricular fibrillation in myh7-related hypertrophic cardiomyopathy before onset of ventricular hypertrophy. Heart Rhythm. 2009;6: 1366-1369.
68. Revera M, Van der Merwe L, Heradien M, Goosen A, Corfield VA, Brink PA, Moolman-Smook JC. Long-term follow-up of r403wmyh7 and r92wtnnt2 HCM families: mutations determine left ventricular dimensions but not wall thickness during disease progression. Cardiovasc J Afr. 2007;18:146-153.
69. Moolman JC, Corfield VA, Posen B, Ngumbela K, Seidman C, Brink PA, Watkins H. Sudden death due to troponin T mutations. J Am Coll Cardiol. 1997;29:549-555. (Pubitemid 27116096)
70. Marcus FI, McKenna WJ, Sherrill D, Basso C, Bauce B, Bluemke DA, Calkins H, Corrado D, Cox MG, Daubert JP, Fontaine G, Gear K, Hauer R, Nava A, Picard MH, Protonotarios N, Saffitz JE, Sanborn DM, Steinberg JS, Tandri H, Thiene G, Towbin JA, Tsatsopoulou A, Wichter T, Zareba W. Diagnosis of arrhythmogenic right ventricular cardiomyopathy/dysplasia: proposed modification of the task force criteria. Circulation. 2010;121:1533-1541.
71. Pelliccia A, Fagard R, Bjornstad HH, Anastassakis A, Arbustini E, Assanelli D, Biffi A, Borjesson M, Carre F, Corrado D, Delise P, Dorwarth U, Hirth A, Heidbuchel H, Hoffmann E, Mellwig KP, Panhuyzen-Goedkoop N, Pisani A, Solberg EE, van-Buuren F, Vanhees L, Blomstrom-Lundqvist C, Deligiannis A, Dugmore D, Glikson M, Hoff PI, Hoffmann A, Horstkotte D, Nordrehaug JE, Oudhof J, McKenna WJ, Penco M, Priori S, Reybrouck T, Senden J, Spataro A, Thiene G. Recommendations for competitive sports participation in athletes with cardiovascular disease: a consensus document from the Study Group of Sports Cardiology of the Working Group of Cardiac Rehabilitation and Exercise Physiology and the Working Group of Myocardial and Pericardial Diseases of the European Society of Cardiology. Eur Heart J. 2005;26:1422-1445.
72. Brooke BS, Habashi JP, Judge DP, Patel N, Loeys B, Dietz HC III. Angiotensin II blockade and aortic-root dilation in Marfan's syndrome. N Engl J Med. 2008;358:2787-2795. (Pubitemid 351930853)
73. Smets EM, Stam MM, Meulenkamp TM, van Langen IM, Wilde AA, Wiegman A, de Wert GM, Tibben A. Health-related quality of life of children with a positive carrier status for inherited cardiovascular diseases. Am J Med Genet A. 2008;146A:700-707. (Pubitemid 351354145)
74. Meulenkamp TM, Tibben A, Mollema ED, van Langen IM, Wiegman A, de Wert GM, de Beaufort ID, Wilde AA, Smets EM. Predictive genetic testing for cardiovascular diseases: impact on carrier children. Am J Med Genet A. 2008;146A:3136-3146.
75. Duncan RE, Delatycki MB. Predictive genetic testing in young people for adult-onset conditions: where is the empirical evidence? Clin Genet. 2006;69:8-20.
76. Hendriks KS, Grosfeld FJ, Wilde AA, van den Bout J, van Langen IM, van Tintelen JP, ten Kroode HF. High distress in parents whose children undergo predictive testing for long QT syndrome. Community Genet. 2005;8:103-113. (Pubitemid 40827618)
77. Andersen J, Oyen N, Bjorvatn C, Gjengedal E. Living with long QT syndrome: a qualitative study of coping with increased risk of sudden cardiac death. J Genet Couns. 2008;17:489-498.
78. Calzone KA, Biesecker BB. Genetic testing for cancer predisposition. Cancer Nurs. 2002;25:15-27.
79. Knoppers BM. ASHG statement: professional disclosure of familial genetic information: the American Society of Human Genetics Social Issues Subcommittee on Familial Disclosure. Am J Hum Genet. 1998;62: 474-483.
80. Lehmann LS, Weeks JC, Klar N, Biener L, Garber JE. Disclosure of familial genetic information: perceptions of the duty to inform. Am J Med. 2000;109:705-711. (Pubitemid 32013018)
81. van der Roest WP, Pennings JM, Bakker M, van den Berg MP, van Tintelen JP. Family letters are an effective way to inform relatives about inherited cardiac disease. Am J Med Genet A. 2009;149A:357-363.
82. Klitzman R. Views of discrimination among individuals confronting genetic disease. J Genet Couns. 2010;19:68-83.
83. Smith JA, Dancyger C, Wallace M, Jacobs C, Michie S. The development of a methodology for examining the process of family communication of genetic test results. J Genet Couns. 2010, September 11 [Epub ahead of print].