Cognitive and emotional factors predicting decisional conflict among high-risk breast cancer survivors who receive uninformative BRCA1/2 results.
OBJECTIVE
To investigate high-risk breast cancer survivors' risk reduction decision making and decisional conflict after an uninformative BRCA1/2 test.


METHODS
Prospective, longitudinal study of 182 probands undergoing BRCA1/2 testing, with assessments 1-, 6-, and 12-months postdisclosure.


METHODS
Primary predictors were health beliefs and emotional responses to testing assessed 1-month postdisclosure. Main outcomes included women's perception of whether they had made a final risk management decision (decision status) and decisional conflict related to this issue.


RESULTS
There were four patterns of decision making, depending on how long it took women to make a final decision and the stability of their decision status across assessments. Late decision makers and nondecision makers reported the highest decisional conflict; however, substantial numbers of women--even early and intermediate decision makers--reported elevated decisional conflict. Analyses predicting decisional conflict 1- and 12-months postdisclosure found that, after accounting for control variables and decision status, health beliefs and emotional factors predicted decisional conflict at different timepoints, with health beliefs more important 1 month after test disclosure and emotional factors more important 1 year later.


CONCLUSIONS
Many of these women may benefit from decision making assistance.
Rini
Christine
C
Department of Oncological Sciences.
O'Neill
Suzanne C
SC
Lombardi Comprehensive Cancer Center.
Valdimarsdottir
Heiddis
H
Department of Oncological Sciences.
Goldsmith
Rachel E
RE
Department of Oncological Sciences.
Jandorf
Lina
L
Department of Oncological Sciences.
Brown
Karen
K
Department of Genetics and Genomic Sciences.
DeMarco
Tiffani A
TA
Lombardi Comprehensive Cancer Center.
Peshkin
Beth N
BN
Lombardi Comprehensive Cancer Center.
Schwartz
Marc D
MD
Lombardi Comprehensive Cancer Center.
D051017:Apoptosis Regulatory Proteins; D019313:BRCA1 Protein / Q000235:genetics*; D024682:BRCA2 Protein / Q000235:genetics*; D001943:Breast Neoplasms / Q000235:genetics* / Q000517:prevention & control / Q000523:psychology*; D003220:Conflict, Psychological; D004252:DNA Mutational Analysis; D003657:Decision Making; D005260:Female; D005817:Genetic Counseling; D020022:Genetic Predisposition to Disease / Q000235:genetics* / Q000523:psychology*; D005820:Genetic Testing / Q000523:psychology*; D015438:Health Behavior; D006801:Humans; D008137:Longitudinal Studies; D008408:Mastectomy / Q000523:psychology; D008875:Middle Aged; D009042:Motivation; D010051:Ovarian Neoplasms / Q000235:genetics / Q000523:psychology; D011446:Prospective Studies; D018570:Risk Assessment; D017741:Survivors / Q000523:psychology*
D051017:Apoptosis Regulatory Proteins; C118024:BLID protein, human; D019313:BRCA1 Protein; C492913:BRCA1 protein, human; D024682:BRCA2 Protein; C551750:BRCA2 protein, human