Green, M. J., Peterson, S. K., Baker, M. W., Harper, G. R., Friedman, L. C., Rubinstein, W.S., & Mauger, D. T. (2004). Effect of a computer-based decision aid on knowledge, perceptions, and intentions about genetic testing for breast cancer susceptibility. Journal of the American Medical Association, 292(4), 442-452.
Breast Cancer Risk & Genetic Testing
|Program Title||Breast Cancer Risk & Genetic Testing|
|Purpose||Designed to enhance knowledge in the decision making process for genetic testing for breast cancer susceptibility. (2004)|
|Program Focus||Awareness building and Improve decision making|
|Topic||Informed Decision Making, Public Health Genomics|
|Age||This information has not been reported.|
|Gender||This information has not been reported.|
|Race/Ethnicity||This information has not been reported.|
|Setting||This information has not been reported.|
|Funded by||NCI (Grant number(s): CA84770, CA70638)|
|User Reviews||(Be the first to write a review for this program)|
A randomized multi-site study was conducted at six study sites located in Pennsylvania, Texas, and Illinois. The study compared the effectiveness of standard one-on-one genetic counseling versus education by a computer program. The computer-based educational intervention was followed by genetic counseling. Randomized multi-site study participants were predominantly White, relatively young (mean age of 44), well educated, and comfortable using the computer. About 56 percent to 61 percent of the participants had low risk for carrying the BRCA 1/2 mutation; 29 percent to 35 percent had a personal history of breast cancer.
Computer group data presented below were collected before the group received counseling. Results were reported separately for low- and high-risk women.
- Overall, an interactive computer program followed by genetic counseling was shown to be more effective than standard genetic counseling for increasing knowledge of breast cancer and genetic testing among women at low risk of carrying BRCA1 or BRCA2 mutation. Genetic counseling was more effective than the computer program at reducing women's anxiety and facilitating more accurate risk perception.
- The randomized multi-site study indicated that the computer program has the potential to stand alone as an educational intervention for low-risk women, but should be used only as a supplement to genetic counseling for high-risk women.
- Among low-risk women who received counseling only, the percent correct on the knowledge measure increased an average of 29 percent between baseline and completion of genetic counseling. Knowledge increase was 38 percent (p=.03) among low-risk women who had also used the computer program.
- Among high-risk women, knowledge increase was not significantly different between the counseling only and computer groups.
- Among low-risk women, all measures of risk perception decreased more for the counseling only group than for the computer group.
- Intention to undergo testing decreased significantly among low-risk but not high-risk women. The change was greater among the counseling group (p<.001) than the computer group (p=.05). The program informs women that the test is expensive and usually not covered by insurance. The program also describes the advantages and disadvantages of genetic testing, for which the advantages apply more to women with personal or family history of breast cancer.
- Genetic counselors have indicated that a client's use of the computer program shortened counseling sessions and allowed counselors to shift the focus away from basic education and toward personal risk and decision-making.
- Both low- and high-risk women who had received counseling indicated less decisional conflict about genetic testing than the computer group. Low-risk women in the counseling group also indicated higher satisfaction with their decision than women in the computer group.
- State-anxiety scores for the counselor group decreased significantly after counseling among low- and high-risk participants. Anxiety did not change significantly after computer use for either risk group.
- At post-intervention, the overall mean scores for decisional conflict were low in both groups. When analyzed by high and low-risk status, no significant difference was observed between the counselor and computer groups.
Green, M. J. (2000). Commentary: Computers and genetic counseling: Time for a dialogue?. Journal of Genetic Counseling, 9 (4), 359-361.
Green, M. J., Biesecker, B. B., McInerney, A. M., Mauger, D., & Fost, N. (2001). An interactive computer program can effectively educate patients about genetic testing for breast cancer susceptibility. American Journal of Medical Genetics, 103, 16-23.
Green, M. J., & Fost, N. (1997). Issues in genetic testing: Who should provide genetic education prior to gene testing? Computers and other methods for improving patient understanding. Genetic Testing, 1(2), 131-136.
Green, M. J., McInerney, A. M., Biesecker, B. B., & Fost, N. (2001). Education about genetic testing for breast cancer susceptibility: Patient preferences for a computer program or genetic counselor. American Journal of Medical Genetics, 103, 24-31.
Green,M.J.; Peterson,S.K.; Baker,M.W.; Friedman,L.C.; Harper,G.R.; Rubinstein,W.S.; Peters,J.A.; Mauger,D.T.; . (2005). Use of an educational computer program before genetic counseling for breast cancer susceptibility: effects on duration and content of counseling sessions. Genetics in Medicine : Official Journal of the American College of Medical Genetics, 7(4), 221-229.
(Be the first to write a review for this program)