Effects of Individualized Breast Cancer Risk Counseling: a Randomized Trial

Lerman, Caryn; Lustbader, Edward D.; Rimer, Barbara K.; Daly, Mary B.; Miller, Suzanne M.; Sands, Colleen Burke; Balshem, Andrew

doi:10.1093/jnci/87.4.286

Cited by 411 publications

(321 citation statements)

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“…In contrast to the US data (Lerman et al, 1995) a minority of women (14%) had grossly exaggerated preconceptions of their risk and these appeared responsive to counselling. Similar data have been reported from Manchester (Evans et al, 1994) and in our earlier study (Cull et al, 1995 It might have been desirable to have had an objective measure of the women's understanding at baseline.…”

Section: Satisfaction With Cliniccontrasting

confidence: 79%

“…Women with a family history of breast cancer can be expected to have prior beliefs and attitudes about their risk that are likely to influence their receptivity to such information. The only controlled trial of breast cancer risk counselling published to date failed to show any improvement in women's comprehension of their risk (Lerman et al, 1995). The authors suggested that to be effective counselling must address women's specific anxieties about breast cancer.…”

mentioning

confidence: 99%

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The use of videotaped information in cancer genetic counselling: a randomized evaluation study

Cull

Miller²,

Porterfield³

et al. 1998

Br J Cancer

115

102

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Summary A video of introductory information about inherited susceptibility to breast cancer was made in consultation with clinicians in four Scottish cancer family clinics. One hundred and twenty-eight women, newly referred for breast cancer risk counselling were randomized to receive the video before (n = 66) or after (n = 62) counselling. Data were collected before randomization at clinic and by postal follow-up at 1 month. The Video Before group had shorter consultations with the breast surgeon (mean = 1 1.8 min ± 5.4 vs 14.6 ± 7.2 for the Video After group). There was no difference between the groups in the accuracy of their risk estimate after counselling, although the Video Before group scored higher for self-reported (Z= 3.65, d.f. = 1, P< 0.01) and objectively assessed understanding (Z= 2.91, d.f. = 1, P < 0.01). At 1 month follow-up, the Video Before group were less likely to underestimate their risk estimate (38% vs 18%; X2 = 4.62, d.f. = 1, P < 0.05), but there was then no difference between the groups in subjective or objective understanding. Use of the video was not associated with increased distress (GHQ, Spielberger State Anxiety) and was associated with greater satisfaction with the information given at the clinic. This study supports the value of videotape as a method of giving information to prepare women for breast cancer risk counselling. Observations of misunderstandings and distress emphasize the video should be seen as an aid to, not a substitute, for communications at the clinic.

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Section: Satisfaction With Cliniccontrasting

confidence: 79%

mentioning

confidence: 99%

The use of videotaped information in cancer genetic counselling: a randomized evaluation study

Cull

Miller²,

Porterfield³

et al. 1998

Br J Cancer

115

102

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“…35 Intense emotions may be significant barriers to information processing, decision making and surveillance behaviour. Lerman et al 43 demonstrated that risk counselling did not produce improved comprehension in a group of female first-degree relatives of breast cancer patients if the women had high levels of anxiety about breast cancer. The literature has reported inconsistent findings about the relation between threat and health behaviour (such as breast cancer screening).…”

Section: Decision Counsellingmentioning

confidence: 99%

Predictive testing for hereditary breast and ovarian cancer: a psychological framework for pre-test counselling

et al. 2000

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Since the identification of two breast-ovarian cancer susceptibility genes (BRCA1/2), predictive testing for hereditary breast/ovarian cancer (HBOC) has been available. Given the complexity and uncertainties of HBOC and the potential impact of predictive testing on psychological well-being, we offer the test applicants a combination of information-oriented and psychological counselling. In this paper, we describe the multidisciplinary approach for predictive testing for HBOC as a clinical service in Leuven, hereby focusing on psychological and decision counselling practice. Attention is paid to the theoretical framework used for pre-test psychological counselling in Leuven. We discuss three important interacting dimensions of psychological counselling: individual emotional support, decision counselling and support of the family communication process. Decision counselling consists of an evaluation of the cognitive and the emotional processing of the information given and strategies and resources for coping. This serves as a starting point to facilitate free informed decision making. Scenario development is used as a decision aid. European Journal of Human Genetics (2000) 8, 130-136.

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“…Women with a family history of breast/ovarian cancer tend to overestimate their risk of developing cancer (Evans et al, 1993;Watson et al, 1999) and cancer-related distress (Lerman et al, 1995) may interfere with the comprehension of individualised genetic risk information. If genetic testing is to provide benefits, it is important to ensure that those offered testing understand risk information and the advice given, so that informed choices can be made in relation to risk management.…”

mentioning

confidence: 99%

Psychosocial impact of breast/ovarian (BRCA 1/2) cancer-predictive genetic testing in a UK multi-centre clinical cohort

et al. 2004

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This multi-centre UK study assesses the impact of predictive testing for breast and ovarian cancer predisposition genes (BRCA1/2) in the clinical context. In the year following predictive testing, 261 adults (59 male) from nine UK genetics centres participated; 91 gene mutation carriers and 170 noncarriers. Self-report questionnaires were completed at baseline (pre-genetic testing) and 1, 4 and 12 months following the genetic test result. Men were assessed for general mental health (by general health questionnaire (GHQ)) and women for general mental health, cancer-related worry, intrusive and avoidant thoughts, perception of risk and risk management behaviour. Main comparisons were between female carriers and noncarriers on all measures and men and women for general mental health. Female noncarriers benefited psychologically, with significant reductions in cancer-related worry following testing (Po0.001). However, younger female carriers (o50 years) showed a rise in cancer-related worry 1 month post-testing (Po0.05). This returned to pre-testing baseline levels 12 months later, but worry remained significantly higher than noncarriers throughout (Po0.01). There were no significant differences in GHQ scores between males and females (both carriers and noncarriers) at any time point. Female carriers engaged in significantly more risk management strategies than noncarriers in the year following testing (e.g. mammograms; 92% carriers vs 30% noncarriers). In the 12 months post-testing, 28% carriers had bilateral risk-reducing mastectomy and 31% oophorectomy. Oophorectomy was confined to older (mean 41 yrs) women who already had children. However, worry about cancer was not assuaged by surgery following genetic testing, and this requires further investigation. In all, 20% of female carriers reported insurance problems. The data show persistent worry in younger female gene carriers and confirm changes in risk management consistent with carrier status. Men were not adversely affected by genetic testing in terms of their general mental health.

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Effects of Individualized Breast Cancer Risk Counseling: a Randomized Trial

Abstract: Attention to the psychological aspects of breast cancer risk will be critical in the development of risk-counseling programs that incorporate testing for the recently cloned breast cancer susceptibility gene, BRCA1 (and BRCA2 when that gene has also been cloned).

Cited by 411 publications

References 0 publications

The use of videotaped information in cancer genetic counselling: a randomized evaluation study

The use of videotaped information in cancer genetic counselling: a randomized evaluation study

Predictive testing for hereditary breast and ovarian cancer: a psychological framework for pre-test counselling

Psychosocial impact of breast/ovarian (BRCA 1/2) cancer-predictive genetic testing in a UK multi-centre clinical cohort

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