Which factors predict proposal and uptake of psychological counselling after BRCA1/2 test result disclosure?

Psychooncology. 2014 Apr;23(4):420-7. doi: 10.1002/pon.3435. Epub 2013 Oct 11.

Abstract

Objective: The aim of this study is to prospectively determine the factors contributing to whether unaffected women from BRCA1/2 families reported that clinicians proposed psychological consultations and that they had attended these consultations during the genetic testing process.

Methods: A prospective study was performed on a national cohort, using self-administered questionnaires to determine the rates of proposal and use of psychological services at the time of BRCA1/2 test result disclosure (N = 533) and during the first year after disclosure (N = 478) among unaffected French women from BRCA1/2 families who had undergone genetic testing for BRCA1/2. Multivariate adjustment was carried out using logistic regression models fitted using generalized estimation equations, with the genetic testing centre as the clustering variable.

Results: At the time of BRCA1/2 test result disclosure, a psychological consultation was proposed by cancer geneticists to 72% and 32% of the carriers (N = 232) and noncarriers (N = 301), respectively (p < 0.001). One year after disclosure, 21% of the carriers had consulted a psychologist, versus 9% of the noncarriers (p < 0.001). Both the proposal and the uptake depended on the women's BRCA1/2 mutation carrier status (proposal adjusted odds ratio (AOR): 4.9; 95% confidence interval (CI) 3.4-7.2; uptake AOR: 2.2; 95% CI 1.2-4.0), their level of education (proposal AOR: 1.7; 95% CI 1.1-2.7; uptake AOR: 4.5; 95% CI 1.7-12.1) and the distress they experienced about their genetic test results (proposal AOR: 1.02; 95% CI 1.01-1.03; uptake AOR: 1.04; 95% CI 1.02-1.06) CONCLUSIONS: Determinants of the proposal/uptake of psychological consultations in the BRCA1/2 testing process highlight the need for inventive strategies to reach the different types of women's profiles.

Keywords: BRCA1/2; HBOC; breast cancer; epidemiology; genetic testing; psychologist services.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Breast Neoplasms / genetics
  • Breast Neoplasms / psychology
  • Case-Control Studies
  • Cohort Studies
  • Counseling / statistics & numerical data*
  • Depression / psychology
  • Depression / therapy*
  • Educational Status
  • Female
  • Genes, BRCA1*
  • Genes, BRCA2*
  • Genetic Predisposition to Disease / psychology*
  • Genetic Testing*
  • Heterozygote
  • Humans
  • Logistic Models
  • Middle Aged
  • Multivariate Analysis
  • Odds Ratio
  • Ovarian Neoplasms / genetics
  • Ovarian Neoplasms / psychology
  • Prospective Studies
  • Referral and Consultation / statistics & numerical data*
  • Social Support
  • Stress, Psychological / psychology
  • Stress, Psychological / therapy*
  • Truth Disclosure