Deborah Cragun

Deborah Cragun
University of South Florida | USF · Global and Planetary

PhD

About

112
Publications
9,108
Reads
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1,731
Citations
Citations since 2017
55 Research Items
1351 Citations
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2017201820192020202120222023050100150200250300
2017201820192020202120222023050100150200250300
Introduction
Additional affiliations
June 2013 - September 2015
Moffitt Cancer Center
Position
  • PostDoc Position

Publications

Publications (112)
Article
Purpose: Scalable solutions are needed to make pre-test genetic education about inherited cancer risk accessible across diverse and underserved populations. We evaluated an automated strategy to deliver genetic education through a web-based video among young Black females with breast cancer. Methods: 96 participants were recruited through state can...
Article
Full-text available
Using a patient’s genetic information to inform medication prescriptions can be clinically effective; however, the practice has not been widely implemented. Health systems need guidance on how to engage with providers to improve pharmacogenetic test utilization. Approaches from the field of implementation science may shed light on the complex facto...
Article
Genetic counselors (GCs) have traditionally been trained to adopt a position of equipoise or clinical neutrality. They provide information, answer questions, address barriers, and engage in shared decision‐making, but generally, they do not prescribe a genetic test. Historically, GCs have generally been trained not to persuade the ambivalent or res...
Article
Frameworks have been developed to help conceptualize clinical genetic counseling (GC), and observational studies have helped understand the process and content of GC sessions. However, additional research is needed to identify GC skills (behaviors or strategies) that practicing genetic counselors report consciously using to meet certain GC goals an...
Article
Current genetic counseling practice has not been found to significantly increase risk communication between family members. A more diverse set of genetic counseling approaches may be needed. A genetic counseling intervention based on motivational interviewing principles and the extended parallel process model was utilized to increase cascade outcom...
Article
Full-text available
Background Implementing genetic testing for inherited cancer predisposition into routine clinical care offers a tremendous opportunity for cancer prevention and early detection. However, genetic testing itself does not improve outcomes; rather, outcomes depend on implemented follow-up care. The IMPACT study is a hybrid type I randomized effectivene...
Article
Females with a BRCA1/2 (BRCA) pathogenic variant have high lifetime risks for cancer. Regularly updated guidelines are in place that recommend screening and/or surgery to monitor and/or significantly reduce breast or ovarian cancer risk. Follow-up care decision making among this population is important to explore to understand the multi-faceted inf...
Article
Familial hypercholesterolemia (FH) is an inherited condition resulting in increased risk of premature cardiovascular disease. This risk can be reduced with early diagnosis and treatment, but it can be challenging to identify individuals with FH. Cascade screening, the most efficient and cost‐effective identification method, requires FH patients to...
Article
Full-text available
Awareness of the genetic counseling (GC) profession may influence access to genetic services, yet awareness among the U.S. population is unknown. A survey of U.S. adults was conducted using age‐ and sex‐based quotas. Participants were asked if they had heard of the GC profession and to describe what genetic counselors (GCs) do. After reading a brie...
Article
Reasons for limited ethnic and racial diversity among genetic counselors in the United States may be elucidated through better understanding the experiences of individuals from racial/ethnic minority backgrounds who are enrolled in genetic counseling graduate programs as well as recent graduates. Semi‐structured interviews were conducted with racia...
Article
Full-text available
An amendment to this paper has been published and can be accessed via the original article.
Article
To address the increasing demand for inherited cancer genetic testing, we developed and evaluated a web-based educational tool to streamline genetic counseling (GC). Consented patients viewed the initial prototype containing core content (Version 1-Core) and provided feedback through three open-ended survey questions. Additional data were collected...
Article
Objective This study explored motivators and challenges/barriers to sharing personal genetic test results (GTR) with family members (FM). Methods Semi-structured, in-depth interviews were conducted with 62 women who had a pathogenic or likely pathogenic (P/LP) variant in aBRCA, PALB2, CHEK2, or ATM gene. Selective qualitative data analysis focused...
Article
Full-text available
Background Implementation of multifaceted interventions typically involves many diverse elements working together in interrelated ways, including intervention components, implementation strategies, and features of local context. Given this real-world complexity, implementation researchers may be interested in a new mathematical, cross-case method c...
Article
Research on genetic counseling outcomes has examined a range of metrics many that differ in quality and extent of psychometric assessment and in some cases fail to encompass potential benefits of genetic counseling for patients. Although a variety of possible outcomes have been explored, selecting the most important or relevant outcomes and identif...
Article
Identification of inherited breast cancer may guide care. These benefits can be amplified through communication of genetic test results with at‐risk family members and subsequent family testing (FT). Females with a pathogenic/likely pathogenic (P/LP) variant in BRCA1/2, PALB2, CHEK2, and/or ATM were surveyed about family communication (FC) of genet...
Article
Full-text available
We have entered an era of direct-to-consumer (DTC) genomics. Patients have relayed many success stories of DTC genomics about finding causal mutations of genetic diseases before showing any symptoms and taking precautions. However, consumers may also take unnecessary medical actions based on false alarms of “pathogenic alleles”. The severity of thi...
Preprint
Full-text available
Background Implementation of multifaceted interventions typically involves many diverse elements working together in interrelated ways, including intervention components, implementation strategies, and features of local context. Given this real-world complexity, implementation researchers may be interested in a new mathematical, cross-case method c...
Preprint
Full-text available
Background: Implementation of multifaceted interventions typically involves many diverse elements working together in interrelated ways, including intervention components, implementation strategies, and features of local context. Given this real-world complexity, implementation researchers may be interested in a new mathematical, cross-case method...
Article
Full-text available
PurposeIdentification of inherited breast cancer may guide cancer risk management. We sought to compare risk management practices across women with inherited breast cancer genes.Methods Females with a pathogenic/likely pathogenic (P/LP) variant in BRCA1/2, PALB2, CHEK2, and/or ATM were surveyed about cancer risk management. Comparisons were made ac...
Article
Background: Increasing demand for genetic testing for inherited cancer risk coupled with a shortage of providers trained in genetics highlight the potential for automated tools embedded in the clinic process to meet this demand. We developed and tested a scalable, easy-to-use, 12-minute web-based educational tool that included standard pretest gen...
Article
Innovations in diagnostic techniques, genomic analysis, stem cell treatments, and gene therapies have the potential to revolutionize our approach to many birth defects and genetic diseases that we are presently able to manage only after birth. In their review of gene and stem cell therapies for fetal care in this issue of JAMA Pediatrics, O’Connell...
Article
Background - Increasing use of genetic tests have identified many variants of uncertain significance (VUS) in genes associated with inherited arrhythmias and cardiomyopathies. Evaluation of clinical practices, including medical management recommendations for VUS patients and their families, is important to prevent over- or under-treatment that may...
Article
1532 Background: Identification of inherited breast cancer may guide care, with benefits amplified through family testing. Methods: Females with a pathogenic/likely pathogenic (P/LP) variant in BRCA1/2, PALB2, CHEK2, and/or ATM were surveyed about cancer risk management, family communication of genetic test results, and family testing. Comparisons...
Preprint
Full-text available
Background: Implementation of multifaceted interventions typically involves many diverse elements working together in interrelated ways, including intervention components, implementation strategies, and features of local context. Given this real-world complexity, implementation researchers may be interested in a new mathematical, cross-case method...
Article
As genetic counseling services expand and reach a wider catchment of the population, there is a critical need to better understand the impact of services on a greater diversity of patients. We conducted a systematic review to evaluate genetic counseling experiences and outcomes among racial and ethnic minorities. Six databases extracted articles pu...
Article
All women diagnosed with breast cancer (BC) ≤age 50 should be referred for genetic counseling (GC) and testing. We sought to compare differences in provider practices and access across a racially and ethnically diverse population of young BC survivors. A registry-based sample of women diagnosed with invasive BC ≤age 50 from 2009 to 2012 was recruit...
Conference Paper
Introduction: Identification of inherited breast cancer (BC) risk through genetic testing (GT) may guide button. Abstracts received without a properly medical care, which can be amplified by sharing test results with relatives. Among women with a completed Disclosure Declaration will not be pathogenic/likely pathogenic (P/LP) variant in an inherite...
Article
Despite higher incidence and mortality of breast cancer among younger Black women, genetic testing outcomes remain severely understudied among Blacks. Past research on disclosure of genetic testing results to family members has disproportionately focused on White, educated, high socioeconomic status women. This study addresses this gap in knowledge...
Article
As technology improves and prices of genetic sequencing continue to decrease, questions arise as to whether implementing universal cancer genetic screening programs to identify those at higher risk for hereditary cancer conditions and offer them genetic sequencing will become obsolete as part of genomic medicine programs in favor of population test...
Article
Background Black women are overrepresented among premenopausal breast cancer (BC) survivors. These patients warrant genetic testing (GT) followed by risk-reducing behaviors. This study documented patterns and predictors of cancer risk-management behaviors among young black BC survivors after GT. Methods Black women (n = 143) with a diagnosis of BC...
Article
Full-text available
Background : Basic and clinical scientific research at the University of South Florida (USF) have intersected to support a multi-faceted approach around a common focus on rare iron-related diseases. We proposed a modified version of the National Center for Biotechnology Information’s (NCBI) Hackathon-model to take full advantage of local expertise...
Conference Paper
Introduction: Per national practice guidelines, pre-test genetic counseling through a provider experienced and proficient in genetics (such as a genetics health professional (GHP)) is recommended prior to genetic testing for hereditary cancer. We sought to determine if there are differences in clinical and demographic variables between young breast...
Article
1579 Background: Per national practice guidelines, pre-test genetic counseling (GC) through a board-certified or credentialed genetics health professional (GHP) is recommended when testing for hereditary cancer. We sought to compare differences in rates of pre-test GC among young breast cancer (BC) patients tested with or without GHP involvement ac...
Article
Aims: This study compared facilitators and barriers to genetic testing and determined awareness about the Genetic Information Nondiscrimination Act (GINA) across young Hispanic and non-Hispanic white (NHW) breast cancer (BC) survivors. Materials and methods: Women diagnosed with BC of age ≤50 years in 2009-2012 were recruited through the Florida...
Article
Full-text available
Background Systematic screening of all colorectal tumors for Lynch Syndrome (LS) has been recommended since 2009. Currently, implementation of LS screening in healthcare systems remains variable, likely because LS screening involves the complex coordination of multiple departments and individuals across the healthcare system. Our specific aims are...
Article
Objective: Prior studies demonstrating minimal psychological consequences for women receiving genetic counseling/genetic testing (GC/GT) for hereditary breast and ovarian cancer rely on predominantly Caucasian women. We conducted a prospective follow‐up of a subset of participants from a population‐based study of Black breast cancer (BC) survivors...
Article
It is becoming increasingly important to identify patients at risk for hereditary colorectal cancer (CRC) given the opportunity to impact medical management and reduce morbidity and mortality among patients and their family members once inherited CRC predisposition is confirmed. Methods by which patients are identified are evolving as genetic testi...
Chapter
Lynch syndrome is estimated to affect 1 out of every 279 individuals worldwide. However, 95% of individuals with Lynch syndrome are not aware of their diagnosis. Therefore, it is important that we maximize all possible efforts to diagnose individuals with Lynch syndrome. Universal tumor screening is one approach that has been successful in helping...
Article
Full-text available
Background Physicians are charged with implementing evidence-based medicine, yet few are trained in the science of Dissemination and Implementation (D&I). In view of the potential of evidence-based training in D&I to help close the gap between research and practice, the goal of this review is to examine the importance of D&I training in medical edu...
Article
In this issue, Kaphingst and colleagues report on young breast cancer patient’s preferences for learning about various results from genomic sequencing. In our commentary, we discuss the results in light of the burgeoning clinical use of whole-exome and whole-genome sequencing (WES/WGS). In particular, we consider findings in the context of a Shared...
Article
Purpose To assess the implementation of evidence-based genomic medicine and its population-level impact on health outcomes and to promote public health genetics interventions, in 2015 the Roundtable on Genomics and Precision Health of the National Academies of Sciences, Engineering, and Medicine formed an action collaborative, the Genomics and Publ...
Article
Conceptual frameworks bring together existing theories and models in order to identify, consolidate, and fill in gaps between theory, practice, and evidence. Given the vast number of possible outcomes that could be studied in genetic counseling, a framework for organizing outcomes and postulating relationships between communication services and gen...
Article
Full-text available
A high proportion of ovarian cancers from women who carry germline mutations in mismatch repair (MMR) genes demonstrate microsatellite instability (MSI). The utility of pre-screening ovarian cancer specimens for MSI to identify potential patients for germline screening for MMR mutations is uncertain. 656 women with malignant ovarian cancer underwen...
Article
e13090 Background: Young black women bear a disproportionate burden of breast cancer (BC), yet there is limited characterization of these cancers based on BRCA1 and BRCA2 ( BRCA) status and tumor genomics. In this pilot study, we characterized: tumor and clinical characteristics based on BRCA carrier status and overlap of basal-like (BL) and triple...
Article
As healthcare reimbursement is increasingly tied to value-of-service, it is critical for the genetic counselor (GC) profession to demonstrate the value added by GCs through outcomes research. We conducted a rapid systematic literature review to identify outcomes of genetic counseling. Web of Science (including PubMed) and CINAHL databases were syst...
Article
Background: Breast cancer (BC) disparities may widen with genomic advances. The authors compared non-Hispanic white (NHW), black, and Hispanic BC survivors for 1) cancer risk-management practices among BRCA carriers and 2) provider discussion and receipt of genetic testing. Methods: A population-based sample of NHW, black, and Hispanic women who...
Article
Introduction: DNA sequencing advances through next-generation sequencing (NGS) and several practice changing events, have led to shifting paradigms for inherited cancer predisposition testing. These changes necessitated a means by which to maximize health benefits without unnecessarily inflating healthcare costs and exacerbating health disparities....
Article
Aims: We describe practitioner knowledge and practices related to Hereditary Breast and Ovarian Cancer (HBOC) in an evolving landscape of genetic testing. Methods: A survey was mailed in late 2013 to Florida providers who order HBOC testing. Descriptive statistics were conducted to characterize participants' responses. Results: Of 101 responde...
Article
Full-text available
Some prior research has found that religiosity and spirituality can be related to health. However, the relationships are inconsistent, measures of religiosity and spirituality are often problematic and conflated with the health outcomes they are supposed to predict, and very little research on this topic specifies which aspects of health supposedly...
Article
LBA1504 Background: Rates of risk-reducing bilateral mastectomy (RRM) or risk-reducing prophylactic oophorectomy (RRSO) among BRCA carriers are based on studies of non-Hispanic whites (NHW), with little known among blacks or Hispanics. Methods: A population-based sample of NHW, black, and Hispanic women diagnosed with invasive BC < age 50 in 2009-1...
Article
Outcomes in the field of genetic counseling have not been well-defined or categorized, despite pressures to provide evidence-based measures in all areas of healthcare. This study describes a process to elucidate and categorize a wide-ranging set of outcomes as characterized by diverse groups of practicing genetic counselors. Semi-structured focus g...
Article
Full-text available
As debates continue about the relevance of religion to health care, research is needed to guide decisions about whether genetic counselors (GCs) should routinely address religious and/or spiritual (R/S) issues with their patients. We conducted an online survey to gauge patient perspectives on this issue. Among the 70 respondents, frequencies of clo...
Article
Unforeseen obstacles and inefficiencies may arise when medical organizations seek to implement protocols that rely upon cooperation and coordination by clinical practitioners from multiple disciplines, departments, and professional orientations. In this reflection, we discuss some ways in which sociological concepts may be useful in forestalling an...
Article
Full-text available
This article introduces the identification, prevention, and treatment of hereditary cancer as an important public health concern. Hereditary cancer research and educational outreach activities are used to illustrate how public health functions can help to achieve health benefits of genetic and genomic medicine. First, we evaluate genetic service de...
Article
Given that Black women remain underrepresented in clinical research studies, we sought to recruit a population-based sample of young Black women with breast cancer through a state cancer registry. Demographic and clinical information on all Black women diagnosed with invasive breast cancer at or below age 50 between 2009 and 2012 in Florida was obt...
Article
BACKGROUND Black women are disproportionately affected with triple-negative breast cancer and have relatively poor survival. To the authors' knowledge, it is not known to what extent differences in the clinical presentation of breast cancer between non-Hispanic white women and black women can be accounted for by the presence of mutations in the BRC...
Article
Concerns about the potential for genomic advances to increase health disparities have been raised. Thus, it is important to assess referral and uptake of genetic counseling (GC) and testing in minority populations at high risk for hereditary breast and ovarian cancer (HBOC). Black women diagnosed with invasive breast cancer ≤age 50 in 2009-2012 wer...
Article
Qualitative comparative analysis (QCA) was developed over 25 years ago to bridge the qualitative and quantitative research gap. On searching PubMed and the Journal of Mixed Methods Research, this review identified 30 original research studies that used QCA. Perceptions that QCA is complex and provides few relative advantages over other methods may...
Article
Institutions have increasingly begun to adopt universal tumor screening (UTS) programs whereby tumors from all newly diagnosed patients with colorectal cancer (CRC) are screened to identify who should be offered germline testing for Lynch syndrome (the most common cause of hereditary CRC). Given limited information about the impact of universal scr...
Article
The Evaluation of Genomic Applications in Practice and Prevention Working Group published an evidence-based recommendation stating that every newly diagnosed colorectal cancer (CRC) should undergo tumor screening for Lynch syndrome (LS). In 2011, leading cancer institutions and public health agencies created the Lynch Syndrome Screening Network (LS...
Article
Purpose: The purpose of this study was to assess potential differences in genetic counseling services delivered by board-certified genetic health-care providers versus non-genetic health-care providers. We evaluated (i) patient recall and content of pretest genetic counseling for hereditary breast and ovarian cancer and (ii) whether full BRCA1 and...
Article
Genetic counseling and testing for hereditary breast and ovarian cancer now includes practitioners from multiple healthcare professions, specialties, and settings. This study examined whether non-genetics professionals (NGPs), perform guideline-based patient intake and informed consent before genetic testing. NGPs offering BRCA testing services in...
Article
Full-text available
Purpose: Universal tumor screening (UTS) for all colorectal cancer patients can improve the identification of Lynch syndrome, the most common cause of hereditary colorectal cancer. This multiple-case study explored how variability in UTS procedures influenced patient follow-through (PF) with germ-line testing after a screen-positive result. Metho...
Data
Descriptions of individuals with a pathogenic mutation in CHEK2 only.
Article
Objective: In epithelial ovarian cancer, concordance between results of microsatellite instability (MSI) and immunohistochemical (IHC) testing has not been demonstrated. This study evaluated the association of MSI-high (MSI-H) status with loss of expression (LoE) of mismatch repair (MMR) proteins on IHC and assessed for potential factors affecting...
Article
Full-text available
Next-generation sequencing enables testing for multiple genes simultaneously ("panel-based testing") as opposed to sequential testing for one inherited condition at a time ("syndrome-based testing"). The current study presents results from patients who underwent hereditary colorectal cancer (CRC) panel-based testing ("ColoNext(TM) "). De-identified...
Article
Full-text available
The purpose of this study was to test whether an interactive, web-based training program is more effective than an existing, flat-text, e-learning program at improving oral health students' knowledge, motivation, and self-efficacy to address signs of disordered eating behaviors with patients. Eighteen oral health classes of dental and dental hygien...
Conference Paper
Oral Health Providers have an opportunity for early detection of disordered eating behaviors as they are often the first health professionals to observe overt signs. An intervention was developed, based on the Information Motivation Behavior (IMB) and Health Belief (HBM) Models, aimed at increasing secondary prevention (SP) behaviors among oral hea...
Article
Young Black women in the United States are disproportionately afflicted with breast cancer, a proportion of which may be due to BRCA1 and BRCA2 (BRCA) gene mutations. In a cancer registry-based sample of young Black women with breast cancer, we evaluated: (1) the prevalence of BRCA mutations detected through full gene sequencing and large rearrange...
Article
Full-text available
With the expansion of genetic testing options due to tremendous advances in sequencing technologies, testing will increasingly be offered by a variety of healthcare providers in diverse settings, as has been observed with BRCA1 and BRCA2 (BRCA) gene testing over the last decade. In an effort to assess the educational needs and preferences of health...
Article
Background Validation of body esteem measures in pre- and early adolescent male and female populations is essential as gender differences regarding weight and body size concerns often emerge during this developmental period. Objective The purpose of the current study was to analyze psychometric properties of the Body Esteem Scale for Adolescents an...
Article
Full-text available
Oral healthcare providers have a clinical opportunity for early detection of disordered eating behaviors because they are often the first health professionals to observe overt oral and physical signs. Curricula regarding early recognition of this oral/systemic medical condition are limited in oral health educational programs. Web-based learning can...