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'Why Don't We Get Counselling?': Comparing NICE Guidelines for Morphological and Genetic Cancer Risk Diagnoses
1Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Psychosocial care guidelines differ between genetic and morphological cancer risks. Despite similar patient needs, historical genetic exceptionalism influences these disparities, suggesting a need for enhanced support for morphological conditions.
Area of Science:
- Oncology
- Psychosocial Care
- Health Policy
Background:
- The UK's National Health Service (NHS) provides psychosocial care for genetic cancer risks but not morphological risks.
- Advancements in diagnosing morphological conditions necessitate evaluating psychosocial support needs.
- Existing disparities in care highlight a gap in supporting patients with conditions like Barrett's oesophagus.
Purpose of the Study:
- To compare National Institute for Health and Care Excellence (NICE) guidelines for genetic (BRCA1/2) and morphological (Barrett's oesophagus) cancer risk conditions.
- To explore the underlying reasons for similarities and differences in psychosocial care recommendations.
- To inform potential improvements in psychosocial support for patients with morphological cancer risks.
Main Methods:
- Comparative analysis of NICE guidelines for BRCA1/2 and Barrett's oesophagus.
- Review of historical and social scientific literature on cancer risk and psychosocial care.
- Theoretical exploration of disparities based on guideline and literature review.
Main Results:
- The 'right not to know' is upheld for genetic risks (BRCA1/2) but not morphological risks (Barrett's oesophagus).
- Specialist counselling is mandated for genetic risk diagnoses, but not for morphological risk diagnoses.
- Identified disparities are attributed to historical genetic exceptionalism, not patient needs.
Conclusions:
- Further psychosocial care may be necessary for individuals with morphological cancer risk conditions.
- Lessons from genetic counselling practices could inform improved psychosocial support for morphological risks.
- Policy review is recommended to ensure equitable psychosocial care across different cancer risk types.
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