Coping Self-Efficacy and Its Relationship with Psychological Morbidity after Genetic Test Result Disclosure: Results from Cancer-Unaffected BRCA1/2 Mutation Carriers

Abstract

Women who are found to carry a BRCA1/2 pathogenic variant experience psychological distress due to an increased risk of breast and ovarian cancer. They may decide between different preventive options. In this secondary analysis of data collected alongside a larger randomized controlled trial, we are looking at 130 newly found BRCA1/2 pathogenic variant carriers and how their coping self-efficacy immediately after genetic test result disclosure is related to their psychological burden and status of preventive decision making. Participants received the Coping Self-Efficacy Scale, the Hospital Anxiety and Depression Scale, the Impact of Event Scale, the Decisional Conflict Scale, and the Stage of Decision-Making Scale after positive genetic test result disclosure. We found that women with higher coping self-efficacy showed fewer symptoms of anxiety or depression and were less affected by receiving the genetic test result in terms of post-traumatic stress. However, coping self-efficacy had no relationship with any decision-related criteria, such as decisional conflict or stage of decision making. This shows that despite its buffering capacity on psychological burden, possessing coping self-efficacy does not lead to more decisiveness in preference-sensitive decisions.

Assessing Psychological Morbidity in Cancer-Unaffected BRCA1/2 Pathogenic Variant Carriers: A Systematic Review

“…By far the most used questionnaire to measure distress was the IES, which was used by 34 studies [ 39 , 40 , 41 , 42 , 45 , 46 , 47 , 50 , 51 , 52 , 54 , 55 , 56 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 74 , 76 , 78 , 79 , 80 , 81 ]. The IES consists of two subscales for intrusion and avoidance.…”

“…The revised IES-R additionally has a hyperarousal subscale. Twenty-eight studies used the original version of the questionnaire (IES), whereas three studies used the revised version (IES-R) [ 54 , 61 , 79 ], and three studies used the intrusion subscale only [ 62 , 70 , 71 ]. While cut-off values have been reported for different populations, they vary by version used and have been criticized for providing little clinical significance.…”

“…Five other studies reported significant decreases in distress after undergoing such risk-reducing surgeries [ 47 , 51 , 66 , 68 , 79 ]. Higher scores were significantly associated with general psychological distress [ 54 ] and with receiving a psychological consultation [ 64 ], providing some evidence for the real-world validity of the IES. In terms of validity, however, one author pointed to the importance of the definition of the “event” in question: test result disclosure or cancer itself [ 45 ].…”

“…Twelve studies assessed anxiety with the anxiety subscale of the HADS (HADS-A) [ 37 , 49 , 50 , 53 , 54 , 59 , 60 , 70 , 71 , 75 , 77 , 78 ]. Among the studies that compared anxiety in carriers with anxiety in non-carriers, two studies reported differences [ 59 , 60 ].…”

“…In contrast to these findings, two other studies found scores well below the clinical threshold for carriers and showed that anxiety scores in carriers were lower compared to women from high-risk families with an absence of demonstrated pathogenic variants [ 49 , 50 ]. Roughly half of the studies included percentages of potential clinical cases (HADS-A score ≥ 8) and reported that roughly one-in-four to one-in-five-carriers (19–24%) showed clinical anxiety [ 49 , 53 , 54 , 59 , 60 , 70 , 71 ]. One study reported almost half (49%) of participants scoring in the clinical anxiety range [ 75 ].…”