Implementation and outcomes of telephone disclosure of clinical BRCA1/2 test results |
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| Institution: | 1. Department of Medicine, Division of Hematology–Oncology, The University of Chicago, Chicago, USA;2. Center for Clinical Cancer Genetics and Global Health, The University of Chicago, Chicago, USA;3. Biostatistics Facility, Fox Chase Cancer Center, Philadelphia, USA;4. Department of Clinical Genetics, Fox Chase Cancer Center, Philadelphia, USA;5. Department of Medicine, Division of Hematology–Oncology, University of Pennsylvania, Philadelphia, USA;6. Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, USA;1. Department of Radiography and Radiology, Faculty of Health Sciences, University of Calabar, Calabar, Nigeria;2. Discipline of Medical Radiation Sciences, Faculty of Health Sciences, University of Sydney, Lidcombe, NSW, Australia;1. Department of Surgery, McMaster University, Hamilton, ON, Canada;2. Department of Surgical Oncology, Hamilton Health Sciences and Juravinski Hospital and Cancer Centre, Hamilton, ON, Canada;3. Department of Oncology, Hamilton Health Sciences and Juravinski Hospital and Cancer Centre, Hamilton, ON, Canada;4. Department of Surgery, St. Joseph''s Healthcare, Hamilton, ON, Canada;5. Department of Clinical Epidemiology and Biostatistics, McMaster University and Biostatistics Unit, St. Joseph''s Healthcare, Hamilton, ON, Canada;6. Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada;1. Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts;1. Cancer Research Division, Cancer Council New South Wales;1. Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, Australia;2. Cancer Research Division, Cancer Council NSW, Sydney, Australia;3. VCS Population Health, VCS Foundation, Level 6, 176 Wellington Parade, East Melbourne, VIC 3002, Australia;4. Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia |
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| Abstract: | ObjectivesWith an increasing demand for genetic services, effective and efficient delivery models for genetic testing are needed.MethodsIn this prospective single-arm communication study, participants received clinical BRCA1/2 results by telephone with a genetic counselor and completed surveys at baseline, after telephone disclosure (TD) and after in-person clinical follow-up.ResultsSixty percent of women agreed to participate; 73% of decliners preferred in-person communication. Anxiety decreased from baseline to post-TD (p = 0.03) and satisfaction increased (p < 0.01). Knowledge did not change significantly from baseline to post-TD, but was higher post-clinical follow-up (p = 0.04). Cancer patients had greater declines in state anxiety and African-American participants reported less increase in satisfaction. 28% of participants did not return for in-person clinical follow-up, particularly those with less formal education, and higher post-disclosure anxiety and depression (p < 0.01).ConclusionsTelephone disclosure of BRCA1/2 test results may not be associated with negative cognitive and affective responses among willing patients, although some subgroups may experience less favorable responses. Some patients do not return for in-person clinical follow-up and longitudinal outcomes are unknown.Practice implicationsFurther evaluation of longitudinal outcomes of telephone disclosure and differences among subgroups can inform how to best incorporate telephone communication into delivery of genetic services. |
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| Keywords: | Genetic testing Cancer susceptibility Cancer risk assessment Communication |
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