PubMed · 6718607
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R Ladouceur, P Mercier. 1984. Awareness: an understudied cognitive factor in behavior therapy.. https://doi.org/10.2466/pr0.1984.54.1.159
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It was our purpose to determine the characteristics of practitioners in the United States who were among the first to inquire about and use the BRCA1 and BRCA2 (BRCA1/2) genetic tests outside of a research protocol. Questionnaires were mailed to all practitioners who requested information on or ordered a BRCA1/2 test from the University of Pennsylvania (UPenn) Genetic Diagnostics Laboratory (GDL) between October 1, 1995 and January 1, 1997 (the first 15 months the test was available for clinical use). The response rate was 67% of practitioners; 54% (121/225) were genetic counselors, 39% (87/225) were physicians or lab directors. Most physicians were oncologists, pathologists, or obstetrician/gynecologists, but 20% practiced surgery or internal or general medicine. Fifty-six percent (125/225) had ordered a BRCA1/2 test for a patient; most of the rest had offered or were willing to offer testing. Of those who had offered testing, 70% had a patient decline BRCA1/2 testing when offered. Practitioners perceived that patients' fear of loss of confidentiality was a major reason for declining. Nearly 60% of practitioners reported that their patients had access to a genetic counselor, but 28% of physicians who ordered a BRCA1/2 test reported having no such access, despite the GDL's counseling requirement. The proportion of physicians reporting no access to genetic counselors for their patients increased from 22.4% in the first half of the study to 50% in the last half. Many practitioners have an interest in BRCA1/2 testing, despite policy statements that discourage its use outside of research protocols. Practitioner responses suggest that patient interest in testing seems to be tempered by knowledge of potential risks. An apparent increase in patient concern about confidentiality and inability to pay for testing could indicate growing barriers to testing. Although most practitioners reported having access to counseling facilities, perceived lack of such access among an increasing proportion of practitioners indicates that lab requirements for counseling are difficult to enforce and suggests that an increasing proportion of patients may not be getting access to counseling.
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Although substance abuse has reached epidemic proportions among people with schizophrenia, relatively little is known about the critical elements of effective treatment of substance abuse in this population. The authors discuss common assumptions about treatment of substance abuse and review the features of the transtheoretical model of change, which is based on the view that behavior change is a longitudinal process consisting of several stages. In this model, substance abusers must first be persuaded to reduce substance use and then be engaged in treatment before they can be taught the skills necessary to become and remain abstinent. The authors suggest an adaptation of the model that attempts to minimize the impact of the cognitive and motivational deficits associated with schizophrenia. The six-month treatment protocol contains four modules focusing on social skills and problem solving, education about the causes and dangers of substance use, motivational interviewing and goal setting for decreased substance use, and training in behavioral skills for relapse prevention. In the 90-minute, twice weekly sessions, behavioral rehearsal is emphasized, and complex social repertoires, such as refusing substances, are divided into smaller behavioral elements.