title: Which factors predict proposal and uptake of psychological counselling after BRCA1/2 test result disclosure?
abstract: OBJECTIVE
  The aim of this study is to prospectively determine the factors contributing to whether unaffected women from BRCA1/2 families reported that clinicians proposed psychological consultations and that they had attended these consultations during the genetic testing process.
  
  
  METHODS
  A prospective study was performed on a national cohort, using self-administered questionnaires to determine the rates of proposal and use of psychological services at the time of BRCA1/2 test result disclosure (N = 533) and during the first year after disclosure (N = 478) among unaffected French women from BRCA1/2 families who had undergone genetic testing for BRCA1/2. Multivariate adjustment was carried out using logistic regression models fitted using generalized estimation equations, with the genetic testing centre as the clustering variable.
  
  
  RESULTS
  At the time of BRCA1/2 test result disclosure, a psychological consultation was proposed by cancer geneticists to 72% and 32% of the carriers (N = 232) and noncarriers (N = 301), respectively (p < 0.001). One year after disclosure, 21% of the carriers had consulted a psychologist, versus 9% of the noncarriers (p < 0.001). Both the proposal and the uptake depended on the women's BRCA1/2 mutation carrier status (proposal adjusted odds ratio (AOR): 4.9; 95% confidence interval (CI) 3.4-7.2; uptake AOR: 2.2; 95% CI 1.2-4.0), their level of education (proposal AOR: 1.7; 95% CI 1.1-2.7; uptake AOR: 4.5; 95% CI 1.7-12.1) and the distress they experienced about their genetic test results (proposal AOR: 1.02; 95% CI 1.01-1.03; uptake AOR: 1.04; 95% CI 1.02-1.06) CONCLUSIONS: Determinants of the proposal/uptake of psychological consultations in the BRCA1/2 testing process highlight the need for inventive strategies to reach the different types of women's profiles.
authors.affiliation: INSERM, UMR912, Marseille, France; Aix-Marseille Université, UMR912, Marseille, France; IRD, UMR912, Marseille, France; McGill University, Montreal, Canada.
authors.forename: Christine
authors.initials: C
authors.lastname: Maheu
authors.forename: Anne-Deborah
authors.initials: AD
authors.lastname: Bouhnik
authors.forename: Catherine
authors.initials: C
authors.lastname: Nogues
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Mouret-Fourme
authors.forename: Dominique
authors.initials: D
authors.lastname: Stoppa-Lyonnet
authors.forename: Christine
authors.initials: C
authors.lastname: Lasset
authors.forename: Pascaline
authors.initials: P
authors.lastname: Berthet
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Fricker
authors.forename: Olivier
authors.initials: O
authors.lastname: Caron
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Luporsi
authors.forename: Laurence
authors.initials: L
authors.lastname: Gladieff
authors.forename: Claire
authors.initials: C
authors.lastname: Julian-Reynier
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000235:genetics / Q000523:psychology; D016022:Case-Control Studies; D015331:Cohort Studies; D003376:Counseling / Q000706:statistics & numerical data*; D003863:Depression / Q000523:psychology / Q000628:therapy*; D004522:Educational Status; D005260:Female; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D020022:Genetic Predisposition to Disease / Q000523:psychology*; D005820:Genetic Testing; D006579:Heterozygote; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010051:Ovarian Neoplasms / Q000235:genetics / Q000523:psychology; D011446:Prospective Studies; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012944:Social Support; D013315:Stress, Psychological / Q000523:psychology / Q000628:therapy*; D014342:Truth Disclosure
keywords: BRCA1/2; HBOC; breast cancer; epidemiology; genetic testing; psychologist services