ABSTRACT
BACKGROUND: Identification of hereditary predisposition to cancer has limited significance if not followed by efficient cancer prevention in the family. Probands are traditionally left to inform their relatives about the increased risk, but distant relatives may remain uninformed. An approach to contacting directly at-risk persons assumed to be unaware of their increased cancer risk was taken. With cancer prevention as the ultimate goal, the study was aimed at investigating attitudes towards and psychosocial consequences of this novel strategy. METHODS: In families with hereditary non-polyposis colorectal cancer (Lynch syndrome), 286 healthy adult relatives with a 50% risk of a predisposing mutation were contacted by letter. Of these, 112 participated in counselling and predictive testing. Baseline information and information obtained 1 month after the test for 73 respondents were compared with 299 corresponding subjects, approached via the proband (family-mediated approach in our previous study) in these families. RESULTS: After the contact letter, 51% consented to the study. Of these, 92% approved of the direct contact and 33% had tried to seek information. In 34% of the mutation carriers, neoplasia was identified in the first post-test colonoscopy. Although post-test fear of cancer increased among the mutation carriers and decreased among noncarriers, almost all participants were satisfied with their decision to participate, independently of their test results, parallel to the family-mediated approach. CONCLUSION: In this large-scale study, relatives in cancer families were actively contacted to inform them of the condition and genetic counselling. Their attitudes were encouraging, and the psychosocial consequences were similar to the family-mediated approach. Our results suggest the appropriateness of direct contact as an alternative method of contact in cases of life-threatening treatable disease.
Subject(s)
Colorectal Neoplasms, Hereditary Nonpolyposis/psychology , Correspondence as Topic , DNA Mutational Analysis/psychology , Duty to Warn , Genetic Counseling/psychology , Persuasive Communication , Professional-Patient Relations , Adult , Aged , Aged, 80 and over , Attitude , Colorectal Neoplasms, Hereditary Nonpolyposis/epidemiology , Colorectal Neoplasms, Hereditary Nonpolyposis/genetics , Communication , Family Relations , Female , Finland , Humans , Male , Middle Aged , Patient Acceptance of Health Care , Psychology , Risk , TelephoneABSTRACT
Mental workload is known to reduce the area of one's visual field, but little is known about its effects on the shape of the visual field. Considering this, the visual fields of 13 subjects were measured concurrently under three levels of mental workload using a Goldmann visual perimeter. Tone counting tasks were employed to induce mental workload, avoiding interference with visual performance. Various methods of shape measurement and analysis were used to investigate the variation of the shape of the visual field as a function of mental load. As expected, the mean area of visual fields reduced to 92.2% in the medium workload condition and to 86.41% under heavy workload, compared to light load condition. This tunnelling effect was not uniform, but resulted in statistically significant shape distortion as well, as measured by the majority of the 12 shape indices used here. These results have visual performance implications in many tasks that are susceptible to changes in visual fields and peripheral vision. Knowledge of the dynamics of the visual field as a function of mental workload can offer significant advantages also in mathematical modelling of visual search.
