title: Cognitive and psychological impact of BRCA genetic counseling in before and after definitive surgery breast cancer patients.
abstract: OBJECTIVE
  To examine changes in cancer-related knowledge, distress, and decisional conflict from pre- to post-genetic counseling (GC) in before (BDS) and after (ADS) definitive surgery breast cancer (BC) patients.
  
  
  METHODS
  Sociodemographic and clinical characteristics were collected at baseline; primary outcome data were collected before (T1) and after (T2) pretest GC. Within group changes for cancer-related knowledge, distress, and decisional conflict over genetic testing were compared by Wilcoxon signed-rank tests.
  
  
  RESULTS
  Of 103 BC patients, 87 were ADS and 16 were BDS. Analyses revealed that both groups reported significant increases in knowledge between T1 and T2 (median change 4.2, p = 0.004, and 2.7, p < 0.001, for BDS and ADS patients, respectively). Overall cancer-related distress showed a downward trend between T1 and T2 for both groups and was significant for BDS patients (p = 0.041). Reports of BDS patients trended toward overall and subscale-specific increases in decisional conflict, with the exception of the uncertainty which trended downward, but did not reach significance. Overall decisional conflict decreased in ADS patients, approaching marginal significance (p = 0.056), with significant improvements in informed decision making (median change -12.6, p < 0.001; i.e., pretest GC yielded improved knowledge of benefits, risks, and side effects of available options).
  
  
  CONCLUSIONS
  These pilot data suggest that pretest GC increases cancer-related knowledge for both BDS and ADS patients, decreases distress in BDS patients, and improves informed decision making in ADS patients. Future studies with larger sample sizes are needed to replicate these results.
authors: Department of Health Outcomes and Behavior, Population Science, Moffitt Cancer Center, Tampa, FL, USA.
authors: Juliette
authors: J
authors: Christie
authors: Gwendolyn P
authors: GP
authors: Quinn
authors: Teri
authors: T
authors: Malo
authors: Ji-Hyun
authors: JH
authors: Lee
authors: Xiuhua
authors: X
authors: Zhao
authors: Jessica
authors: J
authors: McIntyre
authors: Jennifer
authors: J
authors: Brzosowicz
authors: Paul B
authors: PB
authors: Jacobsen
authors: Susan T
authors: ST
authors: Vadaparampil
mesh_terms: D000328:Adult; D000368:Aged; D019313:BRCA1 Protein / Q000235:genetics*; D024682:BRCA2 Protein / Q000235:genetics*; D001943:Breast Neoplasms / Q000235:genetics / Q000523:psychology* / Q000601:surgery; D003071:Cognition; D003220:Conflict, Psychological; D003657:Decision Making; D005260:Female; D005817:Genetic Counseling; D020022:Genetic Predisposition to Disease; D005820:Genetic Testing; D006801:Humans; D019359:Knowledge; D008875:Middle Aged; D009154:Mutation / Q000235:genetics; D055815:Young Adult
chemical_list: D019313:BRCA1 Protein; C492913:BRCA1 protein, human; D024682:BRCA2 Protein; C551750:BRCA2 protein, human