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Genetic counseling for BRCA1 / 2 : A randomized controlled trial of two strategies to facilitate the education and counseling process
Author(s) -
Wang Catharine,
Gonzalez Richard,
Milliron Kara J.,
Strecher Victor J.,
Merajver Sofia D.
Publication year - 2005
Publication title -
american journal of medical genetics part a
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.064
H-Index - 112
eISSN - 1552-4833
pISSN - 1552-4825
DOI - 10.1002/ajmg.a.30577
Subject(s) - worry , genetic counseling , randomized controlled trial , genetic testing , medicine , psychology , checklist , family medicine , clinical psychology , psychiatry , genetics , anxiety , biology , cognitive psychology
Due to the complexity of information surrounding BRCA1 / 2 counseling and testing and its time consuming nature, efforts to facilitate the genetic counseling and education process are needed. Using a 2 × 2 factorial design, two strategies were examined: a CD‐ROM program for patients and a feedback checklist to the genetic counselor on patients' prior misconceptions. A total of 197 women attending a breast and ovarian cancer risk evaluation clinic for BRCA1 / 2 counseling were randomized into one of four conditions: standard care, CD‐ROM only, feedback to counselor only, and both CD‐ROM and feedback. Counseling outcomes included face‐to‐face time with the genetics team, knowledge acquisition, changes in worry about having a gene mutation, and genetic testing decisions. Overall, women who viewed the CD‐ROM spent less time with the genetic counselor and were less likely to undergo genetic testing compared to women who did not view the CD‐ROM. Feedback to the genetic counselor resulted in greater gains in knowledge of genetics and breast cancer. Among women less worried at baseline, those who viewed the CD‐ROM showed no changes in worry following genetic counseling, in contrast to those who did not view the CD‐ROM who increased in worry over time. This latter finding raises concerns about the impact of the increased worry on genetic testing decisions. No interaction effects of the two intervention arms were found. The study results support the importance of both strategies as valuable supplements to clinical BRCA1 / 2 counseling. © 2005 Wiley‐Liss, Inc.