title: Exploring the short-term impact of DNA-testing in breast cancer patients: the counselees' perception matters, but the actual BRCA1/2 result does not.
abstract: OBJECTIVE
  Previous studies suggest that learning a DNA-test-result has no direct impact on the medical-decisions and psychological well-being of counselees. Their perception, especially their recollections and interpretations of their cancer-risks and heredity, predict and/or mediate this impact. These studies were criticized for their small range of predictors, mediators, outcomes and contextual factors. We studied the short-term impact of DNA-testing with an extended model.
  
  
  METHODS
  Three months after disclosure of BRCA1/2-test-results, we sent counselees a questionnaire about their perception, medical and psychological outcomes, and medical, familial and psychological contexts. 248 affected women participated; 30 had received pathogenic-mutations, 16 unclassified-variants and 202 uninformative-results.
  
  
  RESULTS
  The actually communicated genetic-information and the contextual variables predicted the counselees' perception, but did not directly predict any outcomes. The counselees' perception predicted and/or completely mediated the counselees' medical intentions and behavior, physical and psychological life-changes, stigma, mastery, negativity and cancer-worries. Short-term distress was related to the perception not only of their own risks, but also of their relatives' risks and heredity-likelihood. Effect sizes were medium to large.
  
  
  CONCLUSIONS
  The outcomes of DNA-testing were better predicted by the counselees' perception than by the actually given genetic-information. We recommend genetic-counselors to have tailored, interactive dialogues about the counselees' perception.
authors.affiliation: Department of Clinical Genetics, Center for Human and Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands. j.vos@psy.vu.nl
authors.forename: Joël
authors.initials: J
authors.lastname: Vos
authors.forename: Jan C
authors.initials: JC
authors.lastname: Oosterwijk
authors.forename: Encarna
authors.initials: E
authors.lastname: Gomez-Garcia
authors.forename: Fred H
authors.initials: FH
authors.lastname: Menko
authors.forename: Margriet J
authors.initials: MJ
authors.lastname: Collee
authors.forename: Christi J
authors.initials: CJ
authors.lastname: van Asperen
authors.forename: Anna M
authors.initials: AM
authors.lastname: Jansen
authors.forename: Anne M
authors.initials: AM
authors.lastname: Stiggelbout
authors.forename: Aad
authors.initials: A
authors.lastname: Tibben
mesh_terms: D000328:Adult; D000368:Aged; D019313:BRCA1 Protein / Q000235:genetics*; D024682:BRCA2 Protein / Q000235:genetics*; D001943:Breast Neoplasms / Q000175:diagnosis / Q000235:genetics / Q000523:psychology*; D003657:Decision Making; D005260:Female; D005817:Genetic Counseling; D020022:Genetic Predisposition to Disease; D005820:Genetic Testing; D006801:Humans; D011939:Mental Recall; D008875:Middle Aged; D008962:Models, Theoretical; D010465:Perception; D012044:Regression Analysis; D012306:Risk; D011795:Surveys and Questionnaires
chemical_list: D019313:BRCA1 Protein; D024682:BRCA2 Protein