title: Communication and information-giving in high-risk breast cancer consultations: influence on patient outcomes.
abstract: This longitudinal study aimed to document (i) the information-giving and patient-communication styles of clinical geneticists and genetic counsellors (consultants) in familial breast cancer clinics and (ii) assess the effect of these styles on women's knowledge, whether their expectations were met, satisfaction, risk perception and psychological status. A total of 158 women from high-risk breast cancer families completed self-report questionnaires at 2 weeks preconsultation and 4 weeks postconsultation. The consultations were audiotaped, transcribed and coded. Multivariate logistic regressions showed that discussing prophylactic mastectomy (P=0.00) and oophorectomy (P=0.01) led to women having significantly more expectations met; discussing genetic testing significantly decreased anxiety (P=0.03) and facilitating understanding significantly decreased depression (P=0.05). Receiving a summary letter of the consultation significantly lowered anxiety (P=0.01) and significantly increased the accuracy of perceived risk (P=0.02). Women whose consultant used more supportive communications experienced significantly more anxiety about breast cancer at the 4 weeks follow-up (P=0.00). These women were not significantly more anxious before genetic counselling. In conclusion, this study found that consultants vary in the amount of information they give and the way they communicate; and this variation can result in better or worse psychosocial outcomes. Greater use of supportive and counselling communications appeared to increase anxiety about breast cancer. Identifying methods to assist consultants to address emotional issues effectively may be helpful.
authors.affiliation: Medical Psychology Research Unit, Department of Psychological Medicine, The University of Sydney, Sydney NSW 2006, Australia. e.lobb@unsw.edu.au
authors.forename: E A
authors.initials: EA
authors.lastname: Lobb
authors.forename: P N
authors.initials: PN
authors.lastname: Butow
authors.forename: A
authors.initials: A
authors.lastname: Barratt
authors.forename: B
authors.initials: B
authors.lastname: Meiser
authors.forename: C
authors.initials: C
authors.lastname: Gaff
authors.forename: M A
authors.initials: MA
authors.lastname: Young
authors.forename: E
authors.initials: E
authors.lastname: Haan
authors.forename: G
authors.initials: G
authors.lastname: Suthers
authors.forename: M
authors.initials: M
authors.lastname: Gattas
authors.forename: K
authors.initials: K
authors.lastname: Tucker
mesh_terms: D000328:Adult; D000368:Aged; D001007:Anxiety; D001943:Breast Neoplasms / Q000235:genetics* / Q000517:prevention & control / Q000523:psychology; D002173:Cancer Care Facilities; D003142:Communication; D005260:Female; D005817:Genetic Counseling; D020022:Genetic Predisposition to Disease; D005820:Genetic Testing; D006801:Humans; D019359:Knowledge; D008137:Longitudinal Studies; D008408:Mastectomy; D008603:Mental Health; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction; D011369:Professional-Patient Relations; D011379:Prognosis; D012017:Referral and Consultation; D012307:Risk Factors