How the "control-fate continuum" helps explain the genetic testing decision-making process: a grounded theory study

Eur J Hum Genet. 2020 Aug;28(8):1010-1019. doi: 10.1038/s41431-020-0602-3. Epub 2020 Mar 16.


Genetic testing decision-making for cancer predisposition is inherently complex. Understanding the mechanisms and influencing factors of the decision-making process is essential for genetic counselling and has not yet been investigated in Switzerland. This study's aim is thus to provide a theory about the individual's decision-making process regarding genetic testing for cancer predispositions in order to provide medical geneticists and genetic counsellors with insights into the needs and expectations of counsellees. We interviewed at-risk individuals who underwent genetic counselling in a clinical setting in Switzerland, using a grounded theory approach. Based on the interview data, we propose that a control-fate continuum, which is part of the individuals' life philosophy, importantly influences the decision-making process. Those in need for control decide differently compared with those leaving their future to fate. Several psychosocial factors influence the position on the control-fate continuum: "looking for certainty"; "anticipating consequences"; "being socially influenced"; "simplifying risks"; and "deciding intuitively vs reflectively". The control-fate continuum theory gives insights into the possible reasons behind decision-making regarding genetic testing for cancer predispositions. It includes both acceptors and decliners of genetic testing. Our theory helps healthcare professionals offering genetic counselling to anticipate problems within at-risk families and adapting their services to people's needs.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Decision Making*
  • Female
  • Genetic Predisposition to Disease / psychology*
  • Genetic Testing*
  • Grounded Theory*
  • Humans
  • Male
  • Middle Aged
  • Neoplasms / diagnosis
  • Neoplasms / genetics*
  • Neoplasms / psychology
  • Patients / psychology*