The inherited arrhythmia syndrome, Brugada Syndrome (BrS), is a leading cause of autopsy negative sudden death: the sudden arrhythmic death syndrome. Historically, BrS was believed to exhibit a Mendelian (autosomal dominant) mode of inheritance, caused by rare variants in SCN5A, the gene coding for the alpha subunit of the main cardiac sodium voltage channel. Challenges to this paradigm have arisen. For example, the majority of BrS cases do not exhibit rare variants in SCN5A. Moreover, genotype-phenotype mismatch in families has been observed. These findings suggest a more complex genetic architecture underpinning BrS. Subsequent large genomic studies of international patient cohorts have shown an unexpectedly high contribution of common genetic variation to its phenotypic development and severity. This has led to an alternative disease hypothesis whereby BrS develops as result of accumulated genetic and environmental risk surpassing a 'disease threshold' - the higher the accumulated risk, the more severe the clinical phenotype. Whilst expansion of standard clinical genetic testing to include an assessment of common variation might assist with diagnosis and phenotypic severity prediction in BrS, its incorporation into clinical practice presents inherent challenges which require careful consideration.
Language in clinical genetics is never neutral. The terms used to describe genetic concepts, like mutation or variant, sporadic or hereditary, patient or counselee not only shape scientific discourse but also profoundly affect how individuals understand their risks, experience counselling, and make decisions. Terminology carries ethical weight, influencing perceptions of identity, stigma, and inclusion. Precision and empathy in language are therefore central to ethical and effective care. We propose the use of consistent terminology in communication that integrates three ethical responsibilities, promoting inclusivity through careful terminology, fostering psychosocial awareness by recognising that words can evoke fear or stigma, or offer reassurance and communicative clarity. This can be achieved by standardising professional terminology (e.g., variant, sporadic/hereditary) while co-constructing meaning with counselees. We recommend avoiding ambiguous labels like positive or negative, using precise qualifiers for variants and harmonising language across professional disciplines. Communication itself can be a clinical intervention, as careful paraphrasing and clarification both enhance understanding and provide emotional support. As genetic testing becomes increasingly mainstream in oncology, empathetic, precise, and patient-centred communication is essential. By fostering clarity and reducing stigma, language can support informed decision-making, trust, and ultimately, the ethical integration of genetics into everyday healthcare.
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