Predictive genetic testing for cardiovascular diseases: impact on carrier children.
We studied the experiences of children identified by family screening who were found to be a mutation carrier for a genetic cardiovascular disease (Long QT Syndrome (LQTS), Hypertrophic Cardiomyopathy (HCM), Familial Hypercholesterolemia (FH)). We addressed the (a) manner in which they perceive their carrier status, (b) impact on their daily lives, and (c) strategy used to cope with these consequences. Children (aged 8-18) who tested positive for LQTS (n=11), HCM (n=6) or FH (n=16), and their parents participated in semi-structured audiotaped interviews. Interview topics included illness perception, use of medication, lifestyle modifications, worries, and coping. Each interview was coded by two researchers. The qualitative analysis was guided by Leventhal's model of self-regulation. The children were overall quite articulate about the disease they were tested for, including its mode of inheritance. They expressed positive future health perceptions, but feelings of controllability varied. Adherence and side-effects were significant themes with regard to medication-use. Refraining from activities and maintaining a non-fat diet were themes concerning lifestyle modifications. Some children spontaneously reported worries about the possibility of dying and frustration about being different from peers. Children coped with these worries by expressing faith in the effectiveness of medication, trying to be similar to peers or, in contrast, emphasizing their "being different." Children generally appeared effective in the way they coped with their carrier status and its implications. Nevertheless, dealing with the daily implications of their condition remains difficult in some situations, warranting continued availability of psychosocial support.
Meulenkamp
Tineke M
TM
Medical Psychology, Academic Medical Center/University of Amsterdam, and Pediatric Lipid Clinic, Emma's Children Hospital, Amsterdam, The Netherlands.
Tibben
Aad
A
Mollema
Eline D
ED
van Langen
Irene M
IM
Wiegman
Albert
A
de Wert
Guido M
GM
de Beaufort
Inez D
ID
Wilde
Arthur A M
AA
Smets
Ellen M A
EM
D000223:Adaptation, Psychological; D000293:Adolescent; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000235:genetics*; D002648:Child; D003071:Cognition; D003710:Demography; D004644:Emotions; D005260:Female; D005820:Genetic Testing; D006579:Heterozygote; D006801:Humans; D008297:Male; D009154:Mutation / Q000235:genetics; D010290:Parents