Knowledge and Attitudes Toward Genetic Testing in Parkinson’s Disease Dana Lundberg 2006
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Transcript of Knowledge and Attitudes Toward Genetic Testing in Parkinson’s Disease Dana Lundberg 2006
Knowledge and Attitudes Toward Genetic Testing in
Parkinson’s Disease
Dana Lundberg 2006
Parkinson’s Disease
• Is a degenerative neurological disorder
• Affects the substantia nigra, the part of the brain that controls movement
• Includes three symptoms: a resting tremorrigiditybradykinesia (slowness)
Substantia Nigrawww.nlm.nih.gov/medlineplus/
ency/imagepages/19515.htm
• Parkinson’s disease is divided into two onset categories:
Young-onset (less than 50 years at onset)Old-onset (50 years or older at onset)
Onset Categories
Objectives
• To identify attitudes Parkinson’s disease patients have toward diagnostic, predictive, and prenatal genetic testing
• To identify the resources most used by patients for information on Parkinson’s disease
• To assess the level of knowledge patients have about the genetics of Parkinson’s disease
Genetics of Parkinson’s • Studies by Healy et al. (2004), Toft et al. (2005), and
Hattori et al. (2004) revealed several gene mutations
• Genes that mutations have been identified in:- parkin- PINK1- DJ-1- α-Synuclein- LRKK2
• Clinical genetic testing for the parkin and PINK1 genes is available
Rationale•Prior to wide spread use of genetic testing for Parkinson’s
disease researchers need to be aware of:
The interest level in genetic testing
The level of knowledge patients have of genetic testing
Where to target educational programs for genetic testing
• Jacobs et al. showed attitudes toward genetic testing in a young-onset Parkinson’s population:
72% of subjects indicated that they would take a presymptomatic genetic test
57% were interested in the availability of a prenatal genetic test for Parkinson’s
• My study differs:It included both young and old-onset patientsIt included questions regarding sources of information and
knowledge about the genetics of Parkinson’s
Background
Hypothesis
Patients with Parkinson’s disease will respond with a positive attitude toward diagnostic, predictive, and prenatal genetic testing for the disease.
• Struthers Parkinson’s Center (n = 58)• National Parkinson Foundation’s Young-Onset Conference
in Phoenix, AZ (n = 39)
Struthers Parkinson’s Center (Golden Valley, MN)
Young-Onset Parkinson’s Conference (Phoenix, AZ)
Survey Sites
Survey• Demographics• General knowledge about:
Parkinson’s disease genetics genetics of Parkinson’s disease
• Sources of information on Parkinson’s disease• Attitudes toward:
diagnostic genetic testing predictive genetic testing prenatal genetic testing genetic testing at 100%, 90%, and 60% genetic risk
Data Analysis• Data were tabulated in an Excel spreadsheet• Data were analyzed using descriptive and nonlinear
(chi-squared) statistics • P-values were considered significant when p ≤ 0.050
Distribution of Age of Onset
onset < 50 years
onset ≥ 50 years47%53%
Distribution of Gender
MaleFemale
58%42%
Education Levels of Subject Population
High school
Technical training orsome collegeCollege graduate orhigher
19%
16%65%
Distribution of Subjects with Relatives Diagnosed with
Parkinson’s
none≥ 1
79%
21%
0
5
10
15
20
25
30
35
40
45
50
Neurologist
Books/ magazinesLay organizations
Support/ Conference/Edu. programs
InternetNurse
Physical/
Occupational/Speech
Friends/Family
Radio/TV
Primary Care DoctorSources
Number of subjects
< 50 years at onset
≥ 50 years at onset
Sources of InformationP<0.001
0
5
10
15
20
25
30
35
40
45
50
Neurologist
Books/ magazinesLay organizations
Support/ Conference/Edu. programs
InternetNurse
Physical/
Occupational/Speech
Friends/Family
Radio/TV
Primary Care DoctorSources
Number of subjects
< 50 years at onset
≥ 50 years at onset
Sources of InformationP<0.001
0
5
10
15
20
25
30
35
40
45
50
Neurologist
Books/ magazinesLay organizations
Support/ Conference/Edu. programs
InternetNurse
Physical/
Occupational/Speech
Friends/Family
Radio/TV
Primary Care DoctorSources
Number of subjects
< 50 years at onset
≥ 50 years at onset
Sources of InformationP<0.001
0
5
10
15
20
25
30
35
40
45
50
Neurologist
Books/ magazinesLay organizations
Support/ Conference/Edu. programs
InternetNurse
Physical/
Occupational/Speech
Friends/Family
Radio/TV
Primary Care DoctorSources
Number of subjects
< 50 years at onset
≥ 50 years at onset
Sources of Information
P=0.040
Knowledge about Parkinson's and genetics: Number answering correctly (%)
Knowledge Questions:
< 50 years at
onset n (%)
≥ 50 years at onset n (%)
Total (%) p-value
Parkinson's Disease Knowledge Questions:
Parkinson’s disease is less common in people who smoke. 16 (35%) 10 (20%) 27% p = 0.090
Parkinson’s disease always begins after age 50. 45 (98%) 46 (90%) 94% p = 0.120
Parkinson’s disease is caused by a problem in brain cells that use dopamine. 44 (96%) 44 (86%) 91% p = 0.110
There is a gene therapy treatment that can cure Parkinson’s disease. 45 (98%) 47 (92%) 95% p = 0.210
There is an over-the counter, “natural” treatment that can cure Parkinson’s disease. 46 (100%) 48 (94%) 97% p = 0.090
Specific Genetic Questions:A gene is composed of a group of proteins. 9 (20%) 4 (8%) 13% p = 0.090
Genetic diseases always begin in childhood. 39 (85%) 40 (78%) 81% p = 0.440
It is possible to have an abnormal gene without having symptoms of a disease.
43 (93%)
39 (76%) 85% p = 0.020
The Genetics of Parkinson's Disease Questions:
Parkinson’s disease can be caused by a mutation in a gene called parkin. 16
(35%) 4 (8%) 21% p < 0.001
Scientists have identified genes that are associated with a higher risk of Parkinson’s disease.
30 (65%)
19 (37%) 51% p = 0.005
There is a gene test that can identify who will get Parkinson’s disease. 9 (20%) 16 (31%) 26% p = 0.180
Knowledge about Parkinson's and genetics: Number answering correctly (%)
Knowledge Questions:
< 50 years at
onset n (%)
≥ 50 years at onset n (%)
Total (%) p-value
Parkinson's Disease Knowledge Questions:
Parkinson’s disease is less common in people who smoke. 16 (35%) 10 (20%) 27% p = 0.090
Parkinson’s disease always begins after age 50. 45 (98%) 46 (90%) 94% p = 0.120
Parkinson’s disease is caused by a problem in brain cells that use dopamine. 44 (96%) 44 (86%) 91% p = 0.110
There is a gene therapy treatment that can cure Parkinson’s disease. 45 (98%) 47 (92%) 95% p = 0.210
There is an over-the counter, “natural” treatment that can cure Parkinson’s disease. 46 (100%) 48 (94%) 97% p = 0.090
Specific Genetic Questions:A gene is composed of a group of proteins. 9 (20%) 4 (8%) 13% p = 0.090
Genetic diseases always begin in childhood. 39 (85%) 40 (78%) 81% p = 0.440
It is possible to have an abnormal gene without having symptoms of a disease.
43 (93%)
39 (76%) 85% p = 0.020
The Genetics of Parkinson's Disease Questions:
Parkinson’s disease can be caused by a mutation in a gene called parkin. 16
(35%) 4 (8%) 21% p < 0.001
Scientists have identified genes that are associated with a higher risk of Parkinson’s disease.
30 (65%)
19 (37%) 51% p = 0.005
There is a gene test that can identify who will get Parkinson’s disease. 9 (20%) 16 (31%) 26% p = 0.180
Knowledge about Parkinson's and genetics: Number answering correctly (%)
Knowledge Questions:
< 50 years at
onset n (%)
≥ 50 years at onset n (%)
Total (%) p-value
Parkinson's Disease Knowledge Questions:
Parkinson’s disease is less common in people who smoke. 16 (35%) 10 (20%) 27% p = 0.090
Parkinson’s disease always begins after age 50. 45 (98%) 46 (90%) 94% p = 0.120
Parkinson’s disease is caused by a problem in brain cells that use dopamine. 44 (96%) 44 (86%) 91% p = 0.110
There is a gene therapy treatment that can cure Parkinson’s disease. 45 (98%) 47 (92%) 95% p = 0.210
There is an over-the counter, “natural” treatment that can cure Parkinson’s disease. 46 (100%) 48 (94%) 97% p = 0.090
Specific Genetic Questions:A gene is composed of a group of proteins. 9 (20%) 4 (8%) 13% p = 0.090
Genetic diseases always begin in childhood. 39 (85%) 40 (78%) 81% p = 0.440
It is possible to have an abnormal gene without having symptoms of a disease.
43 (93%)
39 (76%) 85% p = 0.020
The Genetics of Parkinson's Disease Questions:
Parkinson’s disease can be caused by a mutation in a gene called parkin. 16
(35%) 4 (8%) 21% p < 0.001
Scientists have identified genes that are associated with a higher risk of Parkinson’s disease.
30 (65%)
19 (37%) 51% p = 0.005
There is a gene test that can identify who will get Parkinson’s disease. 9 (20%) 16 (31%) 26% p = 0.180
Attitudes toward Genetic Testing: Number answering "yes" (%)
Questions
< 50 years at onset
n (%)
≥ 50 years at onset
n (%)Total
(%) p-value
Diagnostic Genetic Testing: Would you take this test?
100% genetic risk 33 (72%) 44 (86%) 79% p = 0.250
90% genetic risk 33 (72%) 41 (80%) 76% p = 0.250
60% genetic risk 23 (50%) 34 (67%) 59% p = 0.100
Predictive Genetic Testing: Do you think this genetic test should be offered to people without symptoms of Parkinson’s disease?
100% genetic risk 36 (78%) 34 (67%) 72% p = 0.250
90% genetic risk 32 (70%) 25 (49%) 59% p = 0.050
60% genetic risk 26 (57%) 25 (49%) 53% p = 0.500
Prenatal Genetic Testing: Do you think a prenatal genetic test should be offered to pregnant mothers?
100% genetic risk 23 (50%) 17 (33%) 41% p = 0.100
90% genetic risk 23 (50%) 15 (29%) 39% p = 0.050
60% genetic risk 21 (46%) 13 (25%) 35% p = 0.050
Attitudes toward Genetic Testing: Number answering "yes" (%)
Questions
< 50 years at onset
n (%)
≥ 50 years at onset
n (%)Total
(%) p-value
Diagnostic Genetic Testing: Would you take this test?
100% genetic risk 33 (72%) 44 (86%) 79% p = 0.250
90% genetic risk 33 (72%) 41 (80%) 76% p = 0.250
60% genetic risk 23 (50%) 34 (67%) 59% p = 0.100
Predictive Genetic Testing: Do you think this genetic test should be offered to people without symptoms of Parkinson’s disease?
100% genetic risk 36 (78%) 34 (67%) 72% p = 0.250
90% genetic risk 32 (70%) 25 (49%) 59% p = 0.050
60% genetic risk 26 (57%) 25 (49%) 53% p = 0.500
Prenatal Genetic Testing: Do you think a prenatal genetic test should be offered to pregnant mothers?
100% genetic risk 23 (50%) 17 (33%) 41% p = 0.100
90% genetic risk 23 (50%) 15 (29%) 39% p = 0.050
60% genetic risk 21 (46%) 13 (25%) 35% p = 0.050
Attitudes toward Genetic Testing: Number answering "yes" (%)
Questions
< 50 years at onset
n (%)
≥ 50 years at onset
n (%)Total
(%) p-value
Diagnostic Genetic Testing: Would you take this test?
100% genetic risk 33 (72%) 44 (86%) 79% p = 0.250
90% genetic risk 33 (72%) 41 (80%) 76% p = 0.250
60% genetic risk 23 (50%) 34 (67%) 59% p = 0.100
Predictive Genetic Testing: Do you think this genetic test should be offered to people without symptoms of Parkinson’s disease?
100% genetic risk 36 (78%) 34 (67%) 72% p = 0.250
90% genetic risk 32 (70%) 25 (49%) 59% p = 0.050
60% genetic risk 26 (57%) 25 (49%) 53% p = 0.500
Prenatal Genetic Testing: Do you think a prenatal genetic test should be offered to pregnant mothers?
100% genetic risk 23 (50%) 17 (33%) 41% p = 0.100
90% genetic risk 23 (50%) 15 (29%) 39% p = 0.050
60% genetic risk 21 (46%) 13 (25%) 35% p = 0.050
Discussion Overall the attitudes expressed towards diagnostic,
predictive, and prenatal genetic testing were positive 1. A majority (≥ 50%) of patients expressed positive attitudes
toward diagnostic genetic testing at all three levels of genetic risk
2. Young-onset patients expressed positive attitudes toward predictive genetic testing slightly more, but not significantly more, than old-onset patients at all three levels of genetic risk
3. Young-onset patients expressed positive attitudes toward prenatal genetic testing significantly more than old-onset at the 90% and 60% levels of genetic risk (p = 0.050 for both tests)
Most commonly used source of information was a neurologist
Young-onset subjects used the internet significantly more than old-onset (p < 0.001)
Young-onset subjects used lay organizations and support groups/conferences significantly more than the old-onset subjects (p < 0.001 for both resources) a majority of the young-onset subjects were interviewed at a
National Parkinson Foundation conference
Young-onset subjects were significantly more knowledgeable about the genetics of Parkinson’s (p < 0.001 and p = 0.005)Number of patients that correctly answered questions in both
the young-onset and, especially, the old-onset groups was low
Discussion
Applications• Educational programmers:
What aspects of Parkinson’s and genetics to focus programs
Where to publish information to best educate the Parkinson’s community about genetic testing
• Pharmaceutical companies:What populations to target for genetic testingAt what levels of genetic risk patients may be interested in
taking genetic tests
Future Work
• Larger subject population through a mailed survey
• Redesign survey to include reasons for accepting or rejecting genetic testing
• Conduct at a conference oriented toward old-onset or both onset groups
Acknowledgements• Dr. Martha Nance• Catherine Wielinski • Ms. Fruen• 2005-06 Research Team
Knowledge and Attitudes Toward Genetic Testing in
Parkinson’s Disease
Dana Lundberg 2006