Effect of a Computer-Based Decision Aid on Knowledge, Perceptions, and Intentions About Genetic Testing for Breast Cancer Susceptibility

Abstract

N RECENT YEARS, GENETIC TESTING for inherited cancer predisposition has become widely available. [1][2][3] Initially, the use of such testing was limited to those enrolled in research studies at specialized medical centers. However, developments in testing technology and widespread publicity in the news media have led to increased testing for conditions such as breast cancer susceptibility 4,5 in primary care [6][7][8] and other settings, raising questions about how to adequately inform patients about their personal breast cancer risk and the pros and cons of genetic testing. 9-11 Professional organizations advise that people who want to learn about their options and alternatives regarding genetic testing should be referred to specialists such as genetic counselors. 12-14 However, there are only about 400 genetic counselors in the United States who identify themselves as specializing in cancer genetics, 15 and cancer genetic counselors are not available in some regions of the Author Affiliations and Financial Disclosures are listed at the end of this article.

Psychiatric implications of cancer genetic testing

“…Several studies suggest using cancer genetic testing decision aids before testing to better inform patients about testing and to assure that they have more accurate risk perceptions. [115][116][117][118] An example of a decision aid used before cancer genetic testing is the computer program "Breast Cancer Risk and Genetic Testing," which is a CD-ROM-based program designed to educate women about breast cancer, heredity, and the benefits and limitations of genetic testing. Users reported that this program was easy to use and provided beneficial educational information before the genetic counseling session, thus allowing the genetic counselors to spend more time discussing specific individual risks and specific psychological concerns.…”

“…Users reported that this program was easy to use and provided beneficial educational information before the genetic counseling session, thus allowing the genetic counselors to spend more time discussing specific individual risks and specific psychological concerns. 117,118 During the first genetic counseling session, a counselor must evaluate an individual's psychological and cognitive functioning and assess their capacity to provide informed consent for testing. Inability to process information secondary to active psychiatric or cognitive impairment could interfere with informed consent.…”

Perceived genetic knowledge, attitudes towards genetic testing, and the relationship between these among patients with a chronic disease

“…Unlike population-based studies (see above), studies investigating genetic knowledge and attitudes in patients usually concentrate on specific disease-related issues [e.g., [15][16][17][18]. The present study aimed to investigate knowledge and attitudes related to genetics and genetic testing in general, among patients with chronic illnesses (e.g., diabetes, heart disease, musculoskeletal disease).…”

Impact of a Randomized Controlled Educational Trial to Improve Physician Practice Behaviors Around Screening for Inherited Breast Cancer

“…Though computer-based curricula aimed at educating patients have been shown to be effective at increasing knowledge about genetic testing for inherited breast cancer, 46,47 educating time-constrained physicians is challenging, and perhaps our goals should shift toward increasing availability of and referrals to genetic counselors.…”