title: Decision making with uncertain information: learning from women in a high risk breast cancer clinic.
abstract: Patients and practitioners may believe that clinically validated laboratory tests provide definitive information. Genetic counselors know this is not always so, and the possibility of inconclusive genetic test results is often discussed in the pretest counseling session. This added discussion topic prolongs the process of genetic counseling, but if there is inadequate patient understanding, patient frustration may be high when receiving a result of uncertain significance, and patients may make decisions about subsequent medical management based on incorrect assumptions. For patients/participants in a research setting, where the clinical validity of testing may be unclear, some patients/participants may still want to use test results to influence their medical management. This paper presents findings from a qualitative study wherein 15 women from the High Risk Breast Cancer Clinic at Utah's Huntsman Cancer Institute discussed how uncertainty regarding results affected their decision making. The women were randomly selected from 3 categories--women with test results of uncertain significance; women without cancer who have a mutation; and women who are members of high-risk families, but for whom no mutation was found. Study findings will be used in future studies to better understand how to improve communication regarding uncertain results, especially in a research environment.
authors.affiliation: Social Research Institute, College of Social Work, University of Utah, Salt Lake City, Utah 84112, USA. caren.frost@socwk.utah.edu
authors.forename: Caren J
authors.initials: CJ
authors.lastname: Frost
authors.forename: Vickie
authors.initials: V
authors.lastname: Venne
authors.forename: Dianne
authors.initials: D
authors.lastname: Cunningham
authors.forename: Ruth
authors.initials: R
authors.lastname: Gerritsen-McKane
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001943:Breast Neoplasms / Q000235:genetics* / Q000523:psychology; D015331:Cohort Studies; D004252:DNA Mutational Analysis; D003657:Decision Making; D005260:Female; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D005817:Genetic Counseling; D005820:Genetic Testing; D014644:Genetic Variation; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology; D010358:Patient Participation / Q000523:psychology; D018570:Risk Assessment; D035501:Uncertainty