title: Disparities in uptake of BRCA1/2 genetic testing in a randomized trial of telephone counseling.
abstract: OBJECTIVE
  As genetic counseling and testing become more fully integrated into clinical care, alternative delivery models are increasingly prominent. This study examines predictors of genetic testing for hereditary breast/ovarian cancer among high-risk women in a randomized trial of in-person versus telephone-based genetic counseling.
  
  
  METHODS
  Methods include multivariable logistic regression and interaction analyses.
  
  
  RESULTS
  Of the 669 participants, 600 completed counseling and 523 received test results. As previously reported, participants randomized to telephone counseling were significantly less likely to be tested. In intention-to-treat analyses, completion of counseling and testing was associated with: race/ethnicity (odds ratio (OR) = 1.96, 95% confidence interval (CI): 1.20-3.20), perceived stress (OR = 0.89, 95% CI: 0.81-0.98), knowledge (OR = 1.12, 95% CI: 1.02-1.23), and randomization group (OR = 1.48, 95% CI: 1.01-2.16). Further, race/ethnicity moderated the association between randomization group and testing; minority women receiving telephone counseling were least likely to complete testing.
  
  
  CONCLUSIONS
  Evidence for logistical and communication-based explanations for this interaction is presented. The overall increased access made possible with telephone genetic counseling should be considered in light of the possibility that this may also lead to lower rates of testing among high-risk minority women. Additional care should be taken to assess and address potential barriers when services are delivered by telephone.Genet Med 17 6, 467-475.
authors.affiliation: Laboratory of Immunology, National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, Maryland, USA.
authors.forename: Morgan
authors.initials: M
authors.lastname: Butrick
authors.affiliation: Department of Oncology, Cancer Prevention and Control Program and Fisher Center for Familial Cancer Research, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA.
authors.forename: Scott
authors.identifier: 0000000203751040
authors.initials: S
authors.lastname: Kelly
authors.affiliation: Department of Oncology, Cancer Prevention and Control Program and Fisher Center for Familial Cancer Research, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA.
authors.forename: Beth N
authors.initials: BN
authors.lastname: Peshkin
authors.affiliation: Department of Biostatistics, Bioinformatics, and Biomathematics, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA.
authors.forename: George
authors.initials: G
authors.lastname: Luta
authors.affiliation: Department of Oncology, Cancer Prevention and Control Program and Fisher Center for Familial Cancer Research, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA.
authors.forename: Rachel
authors.initials: R
authors.lastname: Nusbaum
authors.affiliation: Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA.
authors.forename: Gillian W
authors.initials: GW
authors.lastname: Hooker
authors.affiliation: Department of Oncology, Cancer Prevention and Control Program and Fisher Center for Familial Cancer Research, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA.
authors.forename: Kristi
authors.initials: K
authors.lastname: Graves
authors.affiliation: Department of Oncology, Cancer Prevention and Control Program and Fisher Center for Familial Cancer Research, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Feeley
authors.affiliation: Department of Oncology, Cancer Prevention and Control Program and Fisher Center for Familial Cancer Research, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA.
authors.forename: Claudine
authors.initials: C
authors.lastname: Isaacs
authors.affiliation: Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
authors.forename: Heiddis B
authors.initials: HB
authors.lastname: Valdimarsdottir
authors.affiliation: Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
authors.forename: Lina
authors.initials: L
authors.lastname: Jandorf
authors.affiliation: Department of Oncology, Cancer Prevention and Control Program and Fisher Center for Familial Cancer Research, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA.
authors.forename: Tiffani
authors.initials: T
authors.lastname: DeMarco
authors.affiliation: Familial Cancer Program of the Vermont Cancer Center, University of Vermont College of Medicine, Burlington, Vermont, USA.
authors.forename: Marie
authors.initials: M
authors.lastname: Wood
authors.affiliation: Familial Cancer Program of the Vermont Cancer Center, University of Vermont College of Medicine, Burlington, Vermont, USA.
authors.forename: Wendy
authors.initials: W
authors.lastname: McKinnon
authors.affiliation: Center for Cancer Genetics and Prevention, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Judy
authors.initials: J
authors.lastname: Garber
authors.affiliation: Center for Cancer Genetics and Prevention, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Shelley R
authors.initials: SR
authors.lastname: McCormick
authors.affiliation: Department of Oncology, Cancer Prevention and Control Program and Fisher Center for Familial Cancer Research, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA.
authors.forename: Marc D
authors.initials: MD
authors.lastname: Schwartz
mesh_terms: D000328:Adult; D005260:Female; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D005817:Genetic Counseling; D005820:Genetic Testing; D054625:Healthcare Disparities; D061325:Hereditary Breast and Ovarian Cancer Syndrome / Q000175:diagnosis / Q000453:epidemiology / Q000235:genetics; D006801:Humans; D008875:Middle Aged; D016017:Odds Ratio; D012307:Risk Factors; D013689:Telephone