title: Barriers and facilitators to BRCA genetic counseling among at-risk Latinas in New York City.
abstract: BACKGROUND
  Despite underuse of genetic services for hereditary breast and/or ovarian cancer risk among Latinas (including counseling and testing for BRCA mutations), there is little known about the barriers and facilitators to BRCA genetic counseling among this group. It is imperative to first understand factors that may impede Latinas seeking BRCA genetic counseling, as it is considered a prerequisite to testing.
  
  
  METHODS
  Quantitative telephone interviews (N=120) were conducted with at-risk Latinas in New York City to investigate interest, barriers, and beliefs about BRCA genetic counseling. Statistical analyses examined predictors of intention to undergo BRCA genetic counseling.
  
  
  RESULTS
  Despite moderate levels of awareness, Latinas held largely positive beliefs, attitudes, and knowledge about BRCA genetic counseling. Perceived barriers included logistic concerns (e.g., where to go, cost/health insurance coverage), emotional concerns (e.g., fear, distress), and competing life concerns (e.g., too many other things to worry about, too busy taking care of children or family members). Multivariate results showed that the strongest predictor of intention to undergo BRCA genetic counseling was competing life concerns; Latinas with more competing life concerns were less likely to intend to undergo BRCA genetic counseling (p=0.0002). Other significant predictors of intention included perceived risk of carrying a BRCA mutation (p=0.01) and referral by their physician (p=0.02).
  
  
  CONCLUSIONS
  Educational efforts to promote BRCA genetic counseling among at-risk Latinas and increase referrals by their physicians should incorporate discussion of perceived barriers to counseling, such as competing life concerns that Latinas may need to overcome in order to seek genetic counseling.
authors.affiliation: Department of Oncological Sciences, Cancer Prevention and Control, Mount Sinai School of Medicine, New York, NY 10029, USA. katarina.sussner@mssm.edu
authors.forename: Katarina M
authors.initials: KM
authors.lastname: Sussner
authors.forename: Lina
authors.initials: L
authors.lastname: Jandorf
authors.forename: Hayley S
authors.initials: HS
authors.lastname: Thompson
authors.forename: Heiddis B
authors.initials: HB
authors.lastname: Valdimarsdottir
mesh_terms: D000069:Acculturation; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000208:ethnology / Q000235:genetics* / Q000523:psychology; D002648:Child; D005260:Female; D019398:Genes, BRCA1; D005817:Genetic Counseling / Q000523:psychology*; D020022:Genetic Predisposition to Disease / Q000208:ethnology*; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006630:Hispanic or Latino / Q000235:genetics* / Q000523:psychology; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009519:New York City; D010342:Patient Acceptance of Health Care; D036301:Qualitative Research; D012307:Risk Factors; D012959:Socioeconomic Factors; D055815:Young Adult