title: The roles of family members, health care workers, and others in decision-making processes about genetic testing among individuals at risk for Huntington disease.
abstract: OBJECTIVE
  To understand how individuals at risk for Huntington disease view the roles of others, e.g., family members and health care workers, in decision making about genetic testing.
  
  
  METHODS
  Twenty-one individuals (eight mutation-positive, four mutation-negative, and nine not tested) were interviewed for approximately 2 hours each.
  
  
  RESULTS
  Interviewees illuminated several key aspects of the roles of family members and health care workers (in genetics and other fields) in decision making about testing that have been underexplored. Family members often felt strongly about whether an individual should get tested. Health care workers provided information and assistance with decision making and mental health referrals that were often helpful. Yet health care workers varied in knowledge and sensitivity regarding testing issues, and the quality of counseling and testing experiences can range widely. At times, health care workers without specialized knowledge of Huntington disease offered opinions of whether to test. Input from families and health care workers could also conflict with each other and with an individual's own preferences. Larger institutional and geographic contexts shaped decisions as well.
  
  
  CONCLUSIONS
  Decision-making theories applied to Huntington disease testing have frequently drawn on psychological models, yet the current data highlight the importance of social contexts and relationships in testing decisions. This report, the first to our knowledge to explore individuals' perceptions of social factors (particularly family and health care worker involvement) in Huntington disease testing decisions, has critical implications for practice, education, research, and policy.
authors.affiliation: College of Physicians and Surgeons and Mailman School of Public Health, New York, New York, USA. rlk2@columbia.edu
authors.forename: Robert
authors.initials: R
authors.lastname: Klitzman
authors.forename: Deborah
authors.initials: D
authors.lastname: Thorne
authors.forename: Jennifer
authors.initials: J
authors.lastname: Williamson
authors.forename: Karen
authors.initials: K
authors.lastname: Marder
mesh_terms: D003657:Decision Making / Q000941:ethics; D005190:Family; D005260:Female; D006580:Genetic Carrier Screening; D006282:Health Personnel / Q000941:ethics; D006579:Heterozygote; D006801:Humans; D006816:Huntington Disease / Q000175:diagnosis* / Q000235:genetics; D008297:Male