Which factors predict proposal and uptake of psychological counselling after BRCA1/2 test result disclosure?

• Published in: Psycho-oncology (Chichester, England) Vol. 23; no. 4; pp. 420 - 427
• Main Authors: Maheu, Christine, Bouhnik, Anne-Deborah, Nogues, Catherine, Mouret-Fourme, Emmanuelle, Stoppa-Lyonnet, Dominique, Lasset, Christine, Berthet, Pascaline, Fricker, Jean-Pierre, Caron, Olivier, Luporsi, Elizabeth, Gladieff, Laurence, Julian-Reynier, Claire
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01.04.2014; Wiley Subscription Services, Inc; Wiley
• Subjects: Adjustment; Adult; BRCA1/2; Breast cancer; Breast Neoplasms - genetics; Breast Neoplasms - psychology; Cancer; Case-Control Studies; Cohort Studies; Consultation; Counseling; Counseling - utilization; Depression - psychology; Depression - therapy; Disclosure; Educational Status; epidemiology; Female; Genes, BRCA1; Genes, BRCA2; Genetic Predisposition to Disease - psychology; Genetic Testing; HBOC; Heterozygote; Humans; Life Sciences; Logistic Models; Middle Aged; Multivariate Analysis; Odds Ratio; Ovarian cancer; Ovarian Neoplasms - genetics; Ovarian Neoplasms - psychology; Prospective Studies; psychologist services; Questionnaires; Referral and Consultation - utilization; Regression analysis; Santé publique et épidémiologie; Social Support; Stress, Psychological - psychology; Stress, Psychological - therapy; Truth Disclosure; Uptake; Women; France; BRCA1/2; epidemiology; breast cancer; psychologist services; genetic testing; HBOC
• ISSN: 1057-9249; 1099-1611
• DOI: 10.1002/pon.3435

Objective The aim of this study is to prospectively determine the factors contributing to whether unaffected women from BRCA1/2 families reported that clinicians proposed psychological consultations and that they had attended these consultations during the genetic testing process. Methods A prospective study was performed on a national cohort, using self‐administered questionnaires to determine the rates of proposal and use of psychological services at the time of BRCA1/2 test result disclosure (N = 533) and during the first year after disclosure (N = 478) among unaffected French women from BRCA1/2 families who had undergone genetic testing for BRCA1/2. Multivariate adjustment was carried out using logistic regression models fitted using generalized estimation equations, with the genetic testing centre as the clustering variable. Results At the time of BRCA1/2 test result disclosure, a psychological consultation was proposed by cancer geneticists to 72% and 32% of the carriers (N = 232) and noncarriers (N = 301), respectively (p < 0.001). One year after disclosure, 21% of the carriers had consulted a psychologist, versus 9% of the noncarriers (p < 0.001). Both the proposal and the uptake depended on the women's BRCA1/2 mutation carrier status (proposal adjusted odds ratio (AOR): 4.9; 95% confidence interval (CI) 3.4–7.2; uptake AOR: 2.2; 95% CI 1.2–4.0), their level of education (proposal AOR: 1.7; 95% CI 1.1–2.7; uptake AOR: 4.5; 95% CI 1.7–12.1) and the distress they experienced about their genetic test results (proposal AOR: 1.02; 95% CI 1.01–1.03; uptake AOR: 1.04; 95% CI 1.02–1.06) Conclusions Determinants of the proposal/uptake of psychological consultations in the BRCA1/2 testing process highlight the need for inventive strategies to reach the different types of women's profiles. Copyright © 2013 John Wiley & Sons, Ltd.