Abstract
Genetic testing holds great potential for preventing morbidities and mortalities for a number of diseases through early detection and effective intervention. As the number of genetic tests expand, so will public demand for these services. Therefore, it is essential to evaluate access to genetic testing and genetic services to ensure that all Canadians, including vulnerable groups, have equitable access to all forms of health care, in keeping with the mandate of the Canadian Health Act. The purpose of this paper is to examine the literature to determine if and how the Deaf community, as a vulnerable group, is at an increased risk of inequitable access to genetic services in Canada and to discuss how those who are deaf and hard of hearing are subject to the same risks. First, we define vulnerability and describe why the Deaf community, as a social group, can be considered a vulnerable group, followed by a description of the benefits of genetic testing. Second, we describe the barriers to accessing genetic testing, and how the d/Deaf and hard of hearing population experience additional barriers. Third, we examine the difficulties incorporating genetic testing into medical practice, and how this creates additional barriers to those already at risk. Finally, we discuss the steps necessary to promote equitable access to genetic testing among the d/Deaf and hard of hearing populations within Canada, and provide recommendations for further research in this topic area. Lastly, we comment on how barriers to genetic testing vary among the d/Deaf and hard of hearing is dependent upon the type of health care system available (whether public or private).
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References
Adair A, Hyde-Lay R, Einsiedel E, Caufield T (2009) Technology assessment and resource allocation for predictive genetic testing: a study of the perspectives of Canadian genetic health care providers. BMC Med Ethics 10(6):1–6
Allen B, Meyers N, Sullivan J, Sullivan M (2002) American sign language and end of life care: research in the deaf community. HEC Forum 14(3):197–208
Arnos KS (2003) The implications of genetic testing for deafness. Ear Hear 24:324–331
Barnett S (1993) Clinical and cultural issues in caring for deaf people. Fam Med 31(1):17–22
Booth GL, Hux J (2003) Relationship between avoidable hospitalizations for diabetes mellitus and income level. Arch Intern Med 163:101–106
Boudreault P, Baldwin E, Fox M et al (2010) Deaf adults’ reasons for genetic testing depend on cultural affiliation: results from a prospective, longitudinal genetic counseling and testing study. J Deaf Stud Deaf Educ 15(3):209–227
Brandt R, Ali Z, Sabel A, McHugh T, Gilman P (2008) Cancer genetics evaluation: barriers to and improvements for referral. Genet Test 12(1):9–12
Brunger JW, Murray GS, O’Riordan M, Matthews AL, Smith RJH, Robin NH (2000) Parental attitudes toward genetic testing for pediatric deafness. Am J Hum Genet 67:1621–1625
Burton SK, Widthrow K, Kalfoglou A, Pandya A (2006) A focus group study of consumer attitudes toward genetic testing and newborn screening for deafness. Genet Med 8(12):779–783
Statistics Canada (2008) The Canadian Census mortality follow-up study, 1991 through 2001. Health Rep 19(3):25–43
Canadian Association of the Deaf (May 2010). Available at: http://www.cad.ca/deaf_culture_vs._medicalization.php
Canadian Cancer Society (May 2010) Canadian Cancer Statistics. Available at: http://www.cancer.ca/Canada-wides/About%20cancer/Cancer%20Statistics/Canadian%20Cancer%20Statistics.aspx?=sc_lang=en
Collins FS (2001) Genetics moves into the mainstream. J Am Med Assoc 286(18):2322–2324
Collins FS (2010a) Has the revolution arrived? Nature 464:674–675
Collins FS (2010b) Opportunities for research and NIH. Science 327:36–37
deChesnay M, Anderson B (eds) (2008) Caring for the vulnerable: perspectives in nursing theory, practice and research, 2nd edn. Jones and Bartlett, Sudbury
Doucette L, Merner ND, Cooke S, Ives E, Galutira D, Walsh V et al (2009) Profound, prelingual nonsyndromic deafness maps to chromosome 10q21 and is caused by a novel missense mutation in the Usher syndrome type 1F gene PCDH15. Eur J Hum Genet 17(5):554–564
Fang R, Kmetic A, Millar J, Drasic L (2009) Disparities in chronic disease among Canada’s low income populations. Prev Chron Dis Public Health Res Policy 6(4):1–5
Fink L, Collins F (2000) The human genome project; evolving status and emerging opportunities for disease prevention. In: Khoury MJ, Burke W, Thomson E (eds) Genetics and public health in the 21st century. Oxford University Press, London, p 45
Flaskerud JH, Winslow BJ (1999) Conceptualizing vulnerable populations health related research. Nurs Res 47(2):69–78
Geelhoed EA, Harrison K, Davey A, Walpole IR (2009) Parental perspective of the benefits of genetic testing in children with congenital deafness. Public Health Genomics 12:245–250
Guillemin M, Gillam L (2006) Attitudes to genetic testing for deafness: the importance of informed choice. J Genet Couns 15(1):51–58
Hall M, Olopade O (2005) Confronting genetic disparities: knowledge is power. JAMA 293(14):1783–1785
Hall M, Olopade O (2006) Disparities in genetic testing: thinking outside the BRCA box. Am J Clin Oncol 24(14):2197–2202
Katz SJ, Hofer TP (1994) Socioeconomic disparities in preventative care persist despite universal coverage. JAMA 272(7):530–534
Lynch HT, Lynch PM, Lanspa SJ, Synder CL, Lynch JF, Boland CR (2009) Review of the lynch syndrome: history, medical genetics, screening, differential diagnosis and medical ramifications. Clin Genet 76:1–18
Martinez A, Linden J, Schimmenti LA, Palmer CG (2003) Attitudes of the broader hearing, deaf, and hard-of-hearing community toward genetic testing for deafness. Genet Med 5(2):106–112
McCahon D, Holder R, Metcalfe A, Clifford S, Gill P, Cole T et al (2009) General practitioners’ attitudes to assessment of genetic risk of common disorders in routine primary care. Clin Genet 76(6):544–551
Middelton A, Hewison J, Mueller R (1998) Attitudes of deaf adults toward genetic testing for hereditary deafness. Am J Hum Genet 63:1175–1180
Middelton A, Hewison J, Mueller R (2001) Prenatal diagnosis for inherited deafness-what is the potential demand? J Genet Couns 10(2):121–131
Middelton A, Emery SD, Turner GH (2010) Views, knowledge and beliefs about genetics and genetic counseling among deaf people. Sign Lang Stud 10(2):170–196
Miller FA, Krueger P, Christensen RJ, Ahern C, Carter RF, Kamel-Reid S (2009) Postal survey of physicians and laboratories: practices and perceptions of molecular oncology testing. BMC Health Serv Res 30(9):131
Newfoundland and Labrador Association for the Deaf (NLAD) (2007) Employment and employability in the deaf community: an employability strategy for deaf people within the Northeast Avalon Region. NLAD, St. John’s
Palmer CG, Lueddeke JY, Zhou J (2009) Factors influencing parental decision about genetics evaluation for their deaf or hard-of-hearing child. Genet Med 11(4):248–255
Peinkofer J (1994) HIV education for the deaf, a vulnerable minority. Public Health Rep 109(3):390–396
Pollard R, Barnett S (2009) Health-related vocabulary knowledge among deaf adults. Rehabil Psychol 54(2):182–185
Rogers AC (1997) Vulnerability, health and health care. JAN 27:65–72
Schein J, Miller M (2008) Genetics and deafness: implications for education and life care of deaf students. Am Ann Deaf 153(4):408–410
Smith R, Hone S (2003) Genetic screening for deafness. Pediatr Clin North Am 50:315–329
Stebnicki JA, Coeling HV (1999) The culture of the deaf. J Transcult Nurs 10(4):350–357
Steinberg A, Barnett S, Meador HE, Wiggins EA, Zazove P (2006) Health care system accessibility. J Gen Intern Med 21(3):260–266
Stern SJ, Arnos KS, Murrelle L et al (2002) Attitudes of deaf and hard of hearing subjects towards genetic testing and prenatal diagnosis of hearing loss. J Med Genet 39:449–453
Stuckless S, Parfrey PS, Woods MO, Cox J, Fitzgerald GW, Green JS, Green RC (2007) The phenotypic expression of three MSH2 mutations in large Newfoundland families with Lynch syndrome. Fam Cancer 6(1):1–12
Suther S, Kiros G-E (2009) Barriers to the use of genetic testing: a study of racial and ethnic disparities. Genet Med 11(9):655–662
Taneja PR, Pandya A, Foley D, Nicely LV, Arnos KS (2004) Attitudes of deaf Individuals towards genetic testing. Am J Med Genet 130A:17–21
Taylor M, Edwards J, Ku L (2006) Lost in transition: challenges in the expanding field of adult genetics. Am J Med Genet C Semin Med Genet 142C:294–303
Vasen HF, Moslein G, Alonso A, Aretez S, Bernstein I, Bertario L et al (2010) Recommendations to improve identification of hereditary and familial colorectal cancer in Europe. Fam Cancer 9(2):109–115
Wideroff L, Vadaparampil S, Breen N, Croyle RT, Freedman AN (2003) Awareness of genetic testing for increased cancer risk in the year 2000: national health interview survey. Community Genet 6:147–156
Young IM (1990) Justice and the politics of difference. Princeton University Press, Princeton
Zazove P, Niemann LC, Gorenflo DW, Carmack C, Mehr D, Coyne JC et al (1993) The health status and health care utilization of deaf and hard-of-hearing persons. Arch Fam Med 2:745–752
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This work was funded by the Atlantic Medical Genetics and Genomics Initiative.
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Cooke-Hubley, S., Maddalena, V. Access to genetic testing and genetic counseling in vulnerable populations: the d/Deaf and hard of hearing population. J Community Genet 2, 117–125 (2011). https://doi.org/10.1007/s12687-011-0047-z
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DOI: https://doi.org/10.1007/s12687-011-0047-z