부산대학교 도서관

BACKGROUND: As the availability of genetic testing has increased, so has the need to inform patients about their personal risk and genetic counseling. The number of cancer genetic specialists is insufficient to meet this demand, and therefore a computer-based decision aid was developed to assess its effectiveness in educating women with a history of breast cancer about knowledge, risk perception and genetic testing. OBJECTIVES: To determine whether a computer-based decision aid was as effective as standard genetic counseling for women at low-risk or high-risk of carrying a BRCA1 or BRCA2 mutation. DESIGN: This large, multicenter, randomized trial recruited participants at six sites between May 2000 and September 2002. Inclusion criteria were women aged 18 years or older, able to read, write and speak English, and able to give informed consent, and who were referred for assessment of personal or family histories of breast cancer. Those who had previously undergone genetic counseling or testing for inherited breast cancer susceptibility were excluded. Women were assigned to low-risk or high-risk groups (<10% or ≥10% chance of a BRCA1/2 mutation, respectively) calculated using the BRCAPRO MODEL. INTERVENTION: Women in the 'counselor' group had standard genetic counseling, with education and risk assessment. Women in the 'computer' group accessed the computer-based program, which provided information about breast cancer, heredity and the advantages and limitations of breast cancer susceptibility testing, and additionally received standard counseling. Women completed questionnaires before and after each session. Testing decisions were evaluated at 1 and 6 months. OUTCOME MEASURES: Knowledge of risk perception, intention to undergo genetic testing, decision conflict, satisfaction with decision, anxiety, and satisfaction with intervention were assessed. RESULTS: Of the 211 women enrolled, 55% were low risk and 45% were high risk. A personal history of breast cancer was present in 30%. Both interventions were highly effective at increasing knowledge. Perception of relative risk of developing breast cancer was high at baseline and was lowered after education only in low-risk women in the counselor group. Absolute risk perception of developing breast cancer decreased after either intervention in both groups. In counselor and computer groups, the percentage of low-risk women intending to undergo testing significantly decreased (80% vs 36% and 82% vs 67%, respectively). In the computer group, genetic intention testing further decreased to 42% following counseling. This effect was not seen in the high-risk women. Testing decisions did not differ significantly between the two groups. In low-risk women, those receiving counseling had higher mean satisfaction scores than those in the computer group. Mean state anxiety scores were within normal ranges for both groups at baseline and after each intervention, but were reduced by counseling. CONCLUSION: The computer-based program was useful for increasing knowledge of hereditary breast cancer without increasing anxiety and may reduce unnecessary referrals for genetic counseling in low-risk women.