The Genetics service at Guy’s hospital has dedicated in-house psychology provision aimed at supporting patients embarking on genetic testing through to coping with the aftermath of genetic diagnoses. This provision offers assessment and intervention within a brief 6-session therapy model and provides a range of therapeutic approaches. Patient satisfaction with the service is high and referral rates have greatly increased over the recent years. The Psychology Team also provides indirect support for patients as well as support for the Genetics Team such as contributing to MDT and informal case discussions, as well as teaching and training clinicians about psychological concepts. There are many advantages to having an embedded psychology service both for patients and genetics clinicians, such as good opportunities for liaising around referrals and conducting joint clinical sessions, as well as being easily able to identify psychological training needs. The service plans to further develop by offering group interventions and training opportunities to doctoral psychology trainees. We conclude that clinical psychologists can play a highly integral and essential role in the provision of psychosocial support for clinical genetics teams and provide an overview of the first such integrated clinical psychology service within clinical genetics in the United Kingdom.
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The datasets generated and/or analysed during the current study are available from the corresponding author on reasonable request.
Watson M, Foster C, Eeles R, Ashley S, Davidson R, Mackay J, et al. Psychosocial impact of breast/ovarian (BRCA1/2) cancer-predictive genetic testing in a UK multi-centre clinical cohort. Br J Cancer. 2004;91:1787–94.–
Prospero L, Seminsky M, Honeyford J, Doan B, Franssen E, Meschino W, et al. Psychosocial issues following a positive result of genetic testing for BRCA1 and BRCA2 mutations: findings from a focus group and a needs-assessment survey. Can Med Assoc J. 2001;164:1005–9.
Schwartz MD, Leman C, Brogan B, Peshkin BN, Hughes C, Halbert H, et al. Impact of BRCA1/BRCA2 counselling and testing of newly diagnosed breast cancer patients. J Clin Oncol. 2004;22:1823–9.
Van Roosmalen MS, Stalmeier PFM, Verhoef LCG, Hoekstra-Weebers JEHM, Oosterwijk JC, Hoogerbrugge N, et al. Randomised trial of shared decision-making intervention considering trade offs and individualised treatment information for BRCA1 and 2 carriers. J Clin Oncol. 2004;22:3293–301.
Babb SA, Weisher EM, Heller HN, Whelan AJ, Mutch DG, Herzog TJ, et al. Qualitative evaluation of medical information processing needs of 60 women choosing ovarian cancer surveillance or prophylactic oophorectomy. J Genet Couns. 2004;11:81–96.
Oliveri S, Ferrari F, Manfrinati A, Pravettoni G. A systematic review of the psychological implications of genetic testing: a comparative analysis among cardiovascular, neurodegenerative and cancer diseases. Front Genet. 2018;9:624.
Parens E, Appelbaum PS. On what we have learned and still need to learn about the psychosocial impacts of genetic testing. 2019. Hastings Cent Rep. 2019;49 Suppl 1(Suppl 1):S2–S9.
Patenaude AF. Addressing psychological impacts of genetic testing on patients, families. American Psychological Association. 2013.
National Institute for Health and Care Excellence. Familial breast cancer: classification and care of people at risk of familial breast cancer and management of breast cancer and related risks in people with a family history of breast cancer. Update of clinical guidelines 14 and 41. (Clinical guideline 164) 2013. http://guidance.nice.org.uk/CG164.
Bleiker EM, Aaronson NK, Menko FH, Hahn D, van Asperen CJ, Rutgers EJ, et al. Genetic counselling for hereditary cancer: a pilot study on experiences of patients and family members. Patient Educ Couns. 1997;32:107–16.
Tercyak KP, DeMarco TA, Mars BD, Peshkin BN. Women’s satisfaction with genetic counselling for Hereditary Breast-Ovarian Cancer: psychological aspects. Am J Med Genet. 2004;131:36–41.
Whelan T, Levine M, Willan A, Gafni A, Sanders K, Mirsky D, et al. Effect of a decision aid on knowledge and treatment decision making for breast cancer surgery: a randomized trial. Jama 2004;292:435–41.
Holloway S, Porteous M, Cetnarskyj R, Anderson E, Rush R, Fry A, et al. Patient satisfaction with two different models of cancer genetic services in south-east Scotland. Br J Cancer. 2004;90:582–9.
Spiers J, Smith JA, Ferrer‐Duch M, Moldovan R, Roche J, MacLeod R. Evaluating a genetic counseling narrative group session for people who have tested positive for the Huntington’s disease expansion: An interpretative phenomenological analysis. J Genet Couns. 2020;29:1015–25.
Eisler I, Ellison M, Flinter F, Grey J, Hutchison S, Jackson C, et al. Developing an intervention to facilitate family communication about inherited genetic conditions, and training genetic counsellors in its delivery. Eur J Hum Genet. 2016;24:794–802.
National Institute for Health and Care Excellence. Common mental health problems: identification and pathways to care: Clinical guideline [CG123]. 2011. https://www.nice.org.uk/guidance/cg123/chapter/1-guidance.
David D, Gherman A, Podina I, Mogoase C, Sucala M, Voinescu B. The added value of CBT in the genetic counselling process: concept development, state of the art and new directions. J Ration-Emot Cogn-Behav Ther. 2016;34:310–31. https://doi.org/10.1007/s10942-016-0245-z.
Neilson-Clayton H, Brownlee K. Solution-focused brief therapy with cancer patients and their families. J Psychosoc Oncol. 2002;20:1–3.
Simm R, Iddon J, Barker C. A community pain service solution-focused pain management programme: Delivery and preliminary outcome data. Br J Pain. 2014;81:49–56. http://bjp.sagepub.com/content/8/1/49.full.pdf+html.
Simm R, Barker C. Five years of a community pain service solution-focused pain management programme: extended data and reflections. Br J pain. 2018;12:113–21.
Carr SM, Smith IC, Simm R. Solution-focused brief therapy from the perspective of clients with long-term physical health conditions. Psychol Health Cond. 2014;19:384–91. https://doi.org/10.1080/13548506.2013.824594.
National Institute for Health and Care Excellence Improving supportive and palliative care for adults with cancer. 2004. Cancer Service Guideline [CSG4]. https://www.nice.org.uk/guidance/csg4.
Hayes SC, Strosahl KD, Wilson KG, Acceptance and commitment therapy. Washington, DC: American Psychological Association; 2009.
Zhang CQ, Leeming E, Smith P, Chung PK, Hagger MS, Hayes SC. Acceptance and commitment therapy for health behavior change: a contextually-driven approach. Front Psychol. 2018; 2350.
Feros DL, Lane L, Ciarrochi J, Blackledge JT. Acceptance and Commitment Therapy (ACT) for improving the lives of cancer patients: a preliminary study. Psycho‐Oncol. 2013;22:459–64.
Gilbert P. “The Compassionate Mind Foundation Introduction, Aims and Objectives”. The Compassionate Mind Foundation, 2007. Blake et al. (2011) Psychological care after stroke Improving stroke services for people with cognitive and mood disorders. https://www.nice.org.uk/media/default/sharedlearning/531_strokepsychologicalsupportfinal.pdf.
Craig C, Hiskey S, Spector A. Compassion focused therapy: a systematic review of its effectiveness and acceptability in clinical populations. Expert Rev Neurother. 2020;20:385–400.
Terry M, Leary M. Self-compassion, self-regulation, and health. Self and Identity. 2011; 10:352–362. Chow EOW, Fok, DYH. Recipe of Life: A relational narrative approach in therapy with persons living with chronic pain. Res Soc Work Pract. 2020;30:320–9.
White M, Wijaya M, Epston D. Narrative means to therapeutic ends. WW Norton & Company; 1990.
White MK. Maps of narrative practice. WW Norton & Company; 2007.
Simmonds L, Mozo-Dutton L, editors. Narrative therapy approaches for physical health problems: facilitating preferred change. Routledge; 2018.
Chow EOW, Fok DYH. Recipe of Life: A relational narrative approach in therapy with persons living with chronic pain. Res Soc Work Pract. 2020;30:320–9.
Rajaei A, Brimhall AS, Jensen JF, Schwartz AJ, Torres ET. Striving to thrive: A qualitative study on fostering a relational perspective through narrative therapy in couples facing cancer. Am J Fam Ther. 2021;49:392–408.
Walther S, Redstone A, Holmgren A. Exploring discourses of caring: Trish and the impossible agenda. In Narrative Approaches to Brain Injury 2018 Mar 21 (pp. 101-116). Routledge George E, Iveson C, Ratner H. Problem to solution: Brief therapy with individuals and families. London: BT Press ed, 1990.
White MK. Saying hello again when we have lost someone we love, Ch 8 in Denborough, D. Retelling the stories of our lives: Everyday narrative therapy to draw inspiration and transform experience. WW Norton & Company. 2014.
National Institute for Health and Care Excellence. Familial Breast Cancer CG41, October 2006.
Kroenke K, Spitzer RL, Williams JB. The PHQ‐9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16:606–13.
Spitzer RL, Kroenke K, Williams JW, Löwe B. A brief measure for assessing generalized anxiety disorder: The gad-7. Arch Intern Med. 2006;166:1092–7.
Esplen MJ, Stuckless N, Hunter J, Liede A, Metcalfe K, Glendon G, et al. The BRCA Self‐Concept Scale: a new instrument to measure self‐concept in BRCA1/2 mutation carriers. Psycho‐Oncol: J Psychological, Soc Behav Dimens Cancer. 2009;18:1216–29.
Miller SD, Duncan BL. The outcome rating scale. Chicago, IL: authors. 2000.
Blake et al. (2011) Psychological care after stroke Improving stroke services for people with cognitive and mood disorders. https://www.nice.org.uk/media/default/sharedlearning/531_strokepsychologicalsupportfinal.pdf.
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Firth, C., Tripathi, V., Kowalski Bellamy, A. et al. A unique service: how an embedded psychology team can help patients and genetics clinicians within a clinical genetics service. Eur J Hum Genet (2022). https://doi.org/10.1038/s41431-022-01112-y