title: Longer-term influence of breast cancer genetic counseling on cognitions and distress: smaller benefits for affected versus unaffected women.
abstract: OBJECTIVE
  To evaluate outcomes of breast cancer genetic counseling in women with and without breast cancer.
  
  
  METHODS
  Seventy-seven first-time attendees (n=44 affected) completed questionnaires assessing cognitions (risk accuracy, knowledge, perceived personal control [PPC]) and distress (state anxiety [STAI], cancer-related stress reactions [IES]) from immediately before to immediately and six months after completing counseling. Data were analyzed using multilevel repeated measures and trend analyses.
  
  
  RESULTS
  In affected counselees, mean cognitions did not significantly differ over time, anxiety significantly decreased, and IES levels were increased immediately post-counseling. In unaffected counselees, cognitions significantly improved over time except for knowledge. Distress levels showed similar patterns as in affected women. Improvements in cognitions and distress were significantly smaller in affected versus unaffected women.
  
  
  CONCLUSIONS
  Overall, counseling educates women about breast cancer risk and alleviates their anxiety. Importantly, benefits gained at immediate follow-up seem maintained over time.
  
  
  CONCLUSIONS
  Affected women seem to benefit less from counseling. Counselors may need to devote more effort into educating these women and addressing their anxieties. Future studies should confirm the unexpected finding that cancer-related distress increased immediately post-counseling.
authors.affiliation: Department of Medical Decision Making, Leiden University Medical Centre, Leiden, The Netherlands. a.h.pieterse@lumc.nl
authors.forename: Arwen H
authors.initials: AH
authors.lastname: Pieterse
authors.forename: Margreet G E M
authors.initials: MG
authors.lastname: Ausems
authors.forename: Peter
authors.initials: P
authors.lastname: Spreeuwenberg
authors.forename: Sandra
authors.initials: S
authors.lastname: van Dulmen
mesh_terms: D000293:Adolescent; D000328:Adult; D001007:Anxiety; D001943:Breast Neoplasms / Q000235:genetics / Q000523:psychology*; D018567:Breast Neoplasms, Male / Q000235:genetics / Q000523:psychology*; D003071:Cognition; D005260:Female; D005500:Follow-Up Studies; D005817:Genetic Counseling / Q000523:psychology*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010465:Perception; D012306:Risk; D011795:Surveys and Questionnaires; D013997:Time Factors; D055815:Young Adult