title: Effects of a pre-visit educational website on information recall and needs fulfilment in breast cancer genetic counselling, a randomized controlled trial.
abstract: BACKGROUND
  Pre-visit education which helps counselees to prepare for their first visit for breast cancer genetic counseling might enhance information recall and needs fulfilment. This study assessed the effects of a pre-visit website with tailored information and question prompt sheet (QPS), named E-info geneca.
  
  
  METHODS
  A total of 197 counselees were randomized to receive usual care (UC) or UC plus E-info geneca. All counselees completed a pre- and post-visit questionnaire and visits were videotaped. We studied effects on counselees' information recall, knowledge about breast cancer and heredity, fulfillment of needs, risk perception alignment, anxiety and perceived personal control, using multilevel regression analyses.
  
  
  RESULTS
  Intent-to-treat analysis showed that counselees in the intervention group (n = 103) had higher levels of recall of information from the consultation (β = .32; confidence interval (CI): .04 to .60; P = .02; d = .17) and post-visit knowledge of breast cancer and heredity (β = .30; CI: .03 to .57; P = .03) than counselees in the UC group (n = 94). Also, intervention group counselees reported better fulfilment of information needs (β = .31; CI: .03 to .60; P = .03). The effects of the intervention were strongest for those counselees who did not receive an indication for DNA testing. Their recall scores showed a larger increase (β = .95; CI: .32 to 1.59; P = .003; d = .30) and their anxiety levels dropped more in the intervention compared to the UC group (β = -.60; CI: -1.12 to -.09; P = .02). No intervention effects were found after the first visit on risk perception alignment or perceived personal control.
  
  
  CONCLUSIONS
  This study shows that pre-counseling education, using tailored information technology, leads to more effective first visits for breast cancer genetic counseling, in particular for counselees who received no indication for DNA testing and, therefore, had no indication for a second visit. Future study should focus on the effects of a pre-visit website on the outcomes after a complete series of visits.
  
  
  BACKGROUND
  Dutch Trial Register ISRCTN82643064.
authors.affiliation: NIVEL (Netherlands Institute for Health Services Research), Otterstraat 118-124, Utrecht, 3500 BN, 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: Jozien M
authors.initials: JM
authors.lastname: Bensing
authors.forename: Margreet G E M
authors.initials: MG
authors.lastname: Ausems
mesh_terms: D000328:Adult; D000368:Aged; D001007:Anxiety; D001943:Breast Neoplasms / Q000235:genetics* / Q000523:psychology*; D005260:Female; D005817:Genetic Counseling / Q000379:methods / Q000523:psychology*; D020022:Genetic Predisposition to Disease; D006301:Health Services Needs and Demand; D006801:Humans; D020407:Internet; D011939:Mental Recall; D008875:Middle Aged; D010353:Patient Education as Topic; D010549:Personal Satisfaction; D012017:Referral and Consultation; D011795:Surveys and Questionnaires; D014743:Videotape Recording; D055815:Young Adult