title: A pre-visit website with question prompt sheet for counselees facilitates communication in the first consultation for breast cancer genetic counseling: findings from a randomized controlled trial.
abstract: OBJECTIVE
  The initial breast cancer genetic counseling visit is mainly educational, with large amounts of relatively standard information and little counselee participation. Counselors might provide more counselee-specific information if counselees would participate more. A pre-visit website providing computer-tailored information and a question prompt sheet (QPS) might help counselees to pursue a more active role.
  
  
  METHODS
  Counselees were randomized to receive usual care (UC) or UC plus the pre-visit website. The QPS questions were sent to the counselor before the visit. All counselees completed a baseline questionnaire, and visits were videotaped.
  
  
  RESULTS
  Intervention-group counselees (n = 102) did not ask more questions than UC-group counselees (n = 90). However, counselees in the intervention group more often shared their agenda (B = 10.37; confidence interval (CI) 2.68-18.06; P = 0.01), directed the communication (B = 0.41; CI 0.28-0.53; P = 0.01), and paraphrased the counselors' words (B = 5.18; CI 0.43-9.92; P = 0.03). Counselors introduced and answered the QPS questions. As a result, they provided more information about the topics of these questions, and the information provided was more specific to whether there was an indication for DNA testing.
  
  
  CONCLUSIONS
  A pre-visit website with QPS helped counselees to communicate more assertively. As a result, the information provided was more counselee specific, without affecting the visit duration.
authors.affiliation: Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands. a.albada@nivel.nl
authors.forename: Akke
authors.initials: A
authors.lastname: Albada
authors.forename: Sandra
authors.initials: S
authors.lastname: van Dulmen
authors.forename: Margreet G E M
authors.initials: MG
authors.lastname: Ausems
authors.forename: Jozien M
authors.initials: JM
authors.lastname: Bensing
mesh_terms: D000328:Adult; D000368:Aged; D019313:BRCA1 Protein / Q000235:genetics; D024682:BRCA2 Protein / Q000235:genetics; D001943:Breast Neoplasms / Q000235:genetics / Q000523:psychology*; D003142:Communication; D005260:Female; D005817:Genetic Counseling / Q000379:methods* / Q000523:psychology*; D020022:Genetic Predisposition to Disease; D006301:Health Services Needs and Demand; D006801:Humans; D020407:Internet; D008875:Middle Aged; D010353:Patient Education as Topic; D017060:Patient Satisfaction; D011369:Professional-Patient Relations; D011795:Surveys and Questionnaires; D014741:Video Recording
chemical_list: D019313:BRCA1 Protein; C492913:BRCA1 protein, human; D024682:BRCA2 Protein; C551750:BRCA2 protein, human