title: "What does it mean?": uncertainties in understanding results of chromosomal microarray testing.
abstract: OBJECTIVE
  The increased sensitivity of chromosomal microarray (CMA) technology as compared with traditional cytogenetic analysis allows for improved detection of genomic alterations. However, there is potential for uncertainty in the interpretation of test results in some cases. This paper explores how families understand and make meaning of CMA test results, and identifies the needs of families undergoing CMA testing.
  
  
  METHODS
  We conducted semistructured interviews with parents of 25 pediatric outpatients with CMA test results indicating either a pathogenic alteration or a variant of unknown significance (VUS). Interviews were analyzed qualitatively.
  
  
  RESULTS
  Three domains of understanding were identified: comprehension of results, interpretations of scientific uncertainty, and personal meaning for the child and family. Incomplete comprehension of test results and scientific uncertainty were prominent themes for families receiving results in both the VUS and pathogenic categories. Receiving results from non-geneticists and by telephone, long waits to see a geneticist, and misleading Internet searches all contributed to misunderstandings.
  
  
  CONCLUSIONS
  Differentiating domains of understanding allows for the identification of uncertainties that can be reduced or managed in order to improve understanding of CMA results. Using this framework, we suggest interventions to promote clarity and address the informational needs of families undergoing CMA testing.
authors.affiliation: Center for the Integration of Genetic Healthcare Technologies, Division of Translational Medicine and Human Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. Marian.Reiff@uphs.upenn.edu
authors.forename: Marian
authors.initials: M
authors.lastname: Reiff
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Bernhardt
authors.forename: Surabhi
authors.initials: S
authors.lastname: Mulchandani
authors.forename: Danielle
authors.initials: D
authors.lastname: Soucier
authors.forename: Diana
authors.initials: D
authors.lastname: Cornell
authors.forename: Reed E
authors.initials: RE
authors.lastname: Pyeritz
authors.forename: Nancy B
authors.initials: NB
authors.lastname: Spinner
mesh_terms: D002877:Chromosomes, Human; D003625:Data Collection; D005817:Genetic Counseling; D005820:Genetic Testing / Q000379:methods / Q000592:standards*; D006801:Humans; D007407:Interviews as Topic; D046228:Microarray Analysis; D010045:Outpatients; D010290:Parents / Q000523:psychology; D010353:Patient Education as Topic; D010372:Pediatrics; D035501:Uncertainty