A randomized controlled intervention to promote readiness to genetic counseling for breast cancer survivors

Monica L Kasting; Claire C Conley; Aasha I Hoogland; Courtney L Scherr; Jongphil Kim; Ram Thapa; Maija Reblin; Cathy D Meade; M Catherine Lee; Tuya Pal; Gwendolyn P Quinn; Susan T Vadaparampil

doi:10.1002/pon.5059

A randomized controlled intervention to promote readiness to genetic counseling for breast cancer survivors

Psychooncology. 2019 May;28(5):980-988. doi: 10.1002/pon.5059. Epub 2019 Apr 11.

Authors

Affiliations

¹ Department of Health and Kinesiology, Purdue University, West Lafayette, Indiana.
² Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida.
³ Department of Communication Studies, Northwestern University, Evanston, Illinois.
⁴ Division of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, Florida.
⁵ Comprehensive Breast Program, Moffitt Cancer Center, Tampa, Florida.
⁶ Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
⁷ Department of Obstetrics and Gynecology, New York University, New York, New York.
⁸ Perlumutter Cancer Center, New York University, New York, New York.

Abstract

Objective: Breast cancer (BC) survivors with a genetic mutation are at higher risk for subsequent cancer; knowing genetic risk status could help survivors make decisions about follow-up screening. Uptake of genetic counseling and testing (GC/GT) to determine BRCA status is low among high risk BC survivors. This study assessed feasibility, acceptability, and preliminary efficacy of a newly developed psychoeducational intervention (PEI) for GC/GT.

Methods: High risk BC survivors (N = 119) completed a baseline questionnaire and were randomized to the intervention (PEI video/booklet) or control (factsheet) group. Follow-up questionnaires were completed 2 weeks after baseline (T2), and 4 months after T2 (T3). We analyzed recruitment, retention (feasibility), whether the participant viewed study materials (acceptability), intent to get GC/GT (efficacy), and psychosocial outcomes (eg, perceived risk, Impact of Events Scale [IES]). t tests or chi-square tests identified differences between intervention groups at baseline. Mixed models examined main effects of group, time, and group-by-time interactions.

Results: Groups were similar on demographic characteristics (P ≥ .05). Of participants who completed the baseline questionnaire, 91% followed through to study completion and 92% viewed study materials. A higher percentage of participants in the intervention group moved toward GC/GT (28% vs 8%; P = .027). Mixed models demonstrated significant group-by-time interactions for perceived risk (P = .029), IES (P = .027), and IES avoidance subscale (P = .012).

Conclusions: The PEI was feasible, acceptable, and efficacious. Women in the intervention group reported greater intentions to pursue GC, greater perceived risk, and decreased avoidance. Future studies should seek to first identify system-level barriers and facilitators before aiming to address individual-level barriers.

Keywords: BRCA; cancer; educational intervention; genetic counseling; genetic testing; hereditary breast cancer; oncology; stages of change.

Publication types

Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Breast Neoplasms / genetics
Breast Neoplasms / psychology*
Breast Neoplasms / therapy*
Cancer Survivors / psychology*
Decision Making
Female
Genetic Counseling / psychology*
Genetic Testing / methods
Humans
Mass Screening / psychology*
Middle Aged
Pamphlets
Patient Satisfaction*
Risk Factors
Surveys and Questionnaires

Abstract

Publication types

MeSH terms

Grants and funding