Cognitive and Psychological Impact of BRCA Genetic Counseling in Before and After Definitive Surgery Breast Cancer Patients
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To examine changes in cancer-related knowledge, distress, and decisional conflict from pre- to post-genetic counseling (GC) in before (BDS) and after (ADS) definitive surgery breast cancer (BC) patients.
Sociodemographic and clinical characteristics were collected at baseline; primary outcome data were collected before (T1) and after (T2) pretest GC. Within group changes for cancer-related knowledge, distress, and decisional conflict over genetic testing were compared by Wilcoxon signed-rank tests.
Of 103 BC patients, 87 were ADS and 16 were BDS. Analyses revealed that both groups reported significant increases in knowledge between T1 and T2 (median change 4.2, p = 0.004, and 2.7, p < 0.001, for BDS and ADS patients, respectively). Overall cancer-related distress showed a downward trend between T1 and T2 for both groups and was significant for BDS patients (p = 0.041). Reports of BDS patients trended toward overall and subscale-specific increases in decisional conflict, with the exception of the uncertainty which trended downward, but did not reach significance. Overall decisional conflict decreased in ADS patients, approaching marginal significance (p = 0.056), with significant improvements in informed decision making (median change −12.6, p < 0.001; i.e., pretest GC yielded improved knowledge of benefits, risks, and side effects of available options).
These pilot data suggest that pretest GC increases cancer-related knowledge for both BDS and ADS patients, decreases distress in BDS patients, and improves informed decision making in ADS patients. Future studies with larger sample sizes are needed to replicate these results.
- 6.Daly M, Axilbund JE, Bryant E, et al. The NCCN genetic/familial high-risk assessment: breast and ovarian clinical practice guideline, version 1.2006. http://www.nccn.org/. Accessed 1 Oct 2006.
- 15.Daly M, Axilbund JE, Bryant E, et al. The NCCN genetic/familial high-risk assessment: breast and ovarian clinical practice guideline, version 1.2009. http://www.nccn.org/. Accessed 3 Dec 2009.
- 17.Hewitt M, Greenfield S, Stovall E. From cancer patient to cancer survivor: lost in transition. Washington, DC: National Academies Press, 2005.Google Scholar
- 18.American Society of Clinical Oncology policy statement update: genetic testing for cancer susceptibility. J Clin Oncol. 2003;21:2397–406.Google Scholar
- 29.Vadaparampil ST, Miree CA, Wilson C, Jacobsen PB. Psychosocial and behavioral impact of genetic counseling and testing. Breast Dis. 2007;27:97–108.Google Scholar
- 44.O’Connor AM. User manual—decisional conflict scale. Ottawa: Ottawa Hospital Research Institute, 1993, updated 2010.Google Scholar
- 58.Meiser B, Halliday JL. What is the impact of genetic counselling in women at increased risk of developing hereditary breast cancer? A meta-analytic review. Soc Sci Med. 2002;54:1463–70.Google Scholar