Genetic counseling for BRCA1/2: A randomized controlled trial of two strategies to facilitate the education and counseling process

Authors

  • Catharine Wang,

    Corresponding author
    1. Department of Health Behavior and Health Education, University of Michigan, School of Public Health, Ann Arbor, Michigan
    2. Michigan Center for Genomics and Public Health, University of Michigan, School of Public Health, Ann Arbor, Michigan
    • Michigan Center for Genomics and Public Health, University of Michigan School of Public Health, 611 Church Street, Rm. 262, Ann Arbor, MI 48104-3028.
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  • Richard Gonzalez,

    1. Department of Psychology, University of Michigan, Ann Arbor, Michigan
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  • Kara J. Milliron,

    1. Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
    2. Comprehensive Cancer Center, University of Michigan, Ann Arbor, Michigan
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  • Victor J. Strecher,

    1. Department of Health Behavior and Health Education, University of Michigan, School of Public Health, Ann Arbor, Michigan
    2. Comprehensive Cancer Center, University of Michigan, Ann Arbor, Michigan
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  • Sofia D. Merajver

    1. Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
    2. Comprehensive Cancer Center, University of Michigan, Ann Arbor, Michigan
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Abstract

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.

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