Information-seeking behaviour and psycho-social interactions during the genetic testing process

The use of heuristics in genetic testing decision-making: A qualitative interview study

BACKGROUND

Decision-making concerning predictive genetic testing for hereditary cancer syndromes is inherently complex. This study aims to investigate what kind of complexities adults undergoing genetic counseling in Switzerland experience, how they deal with them, and what heuristics they use during the decision-making process.

METHODS

Semi-structured qualitative interviews with eighteen Swiss adults seeking genetic counseling for hereditary cancer syndrome genetic testing and two counseling physicians were conducted and analyzed using a grounded theory approach.

RESULTS

Counselees stated that once they were aware of their eligibility for genetic testing they perceived an inevitable necessity to make a decision in a context of uncertainties. Some counselees perceived this decision as simple, others as very complex. High emotional involvement increased perceived complexity. We observed six heuristics that counselees used to facilitate their decision: Anticipating the test result; Focusing on consequences; Dealing with information; Interpreting disease risk; Using external guidance; and (Re-)Considering the general uncertainty of life.

LIMITATIONS

Our findings are limited to the context of predictive genetic testing for hereditary cancer syndromes. This qualitative study does not allow extrapolation of the relative frequency of which heuristics occur.

CONCLUSIONS

The use of heuristics is an inherent part of decision-making, particularly in the complex context of genetic testing for inherited cancer predisposition. However, some heuristics increase the risk of misinterpretation or exaggerated external influences. This may negatively impact informed decision-making. Thus, this study illustrates the importance of genetic counselors and medical professionals being aware of these heuristics and the individual manner in which they might be applied in the context of genetic testing decision-making. Findings may offer practical support to achieve this, as they inductively focus on the counselees' perspective.

Considerations for the impact of personal genome information: a study of genomic profiling among genetics and genomics professionals

With the expansion of genomic-based clinical applications, it is important to consider the potential impact of this information particularly in terms of how it may be interpreted and applied to personal perceptions of health. As an initial step to exploring this question, we conducted a study to gain insight into potential psychosocial and health motivations for, as well as impact associated with, undergoing testing and disclosure of individual "variomes" (catalogue of genetic variations). To enable the collection of fully informed opinions, 14 participants with advanced training in genetics underwent whole-genome profiling and received individual reports of estimated genomic ancestry, genotype data and reported disease associations. Emotional, cognitive and health behavioral impact was assessed through one-on-one interviews and questionnaires administered pre-testing and 1-week and 3-months post-testing. Notwithstanding the educational and professional bias of our study population, the results identify several areas of research for consideration within additional populations. With the development of new and less costly approaches to genome risk profiling, now available for purchase direct-to-consumers, it is essential that genome science research be conducted in parallel with studies assessing the societal and policy implications of genome information for personal use.

Prevalence and correlates of mothers and fathers attending pretest cancer genetic counseling together

OBJECTIVE

To determine the prevalence of fathers' attendance at pretest cancer genetic counseling sessions with mothers undergoing BRCA1/2 genetic testing for hereditary breast/ovarian cancer (HBOC) risk, and to identify psychosocial and other correlates of fathers' attendance.

METHODS

One hundred and twenty-one fathers of minor-age children who were spouses/partners of women (mothers) undergoing such counseling and testing were recruited, completed a behavioral self-report survey, and provided data about their sociodemographic backgrounds, father-child cancer communication histories, parenting relationship quality, and information-seeking and perceived knowledge.

RESULTS

A total of 27.3% of fathers attended pretest cancer genetic counseling with mothers. Compared to fathers who did not attend pretest cancer genetic counseling, those who did had stronger parenting alliances with mothers, were more likely to have sought out information about BRCA1/2 testing, and felt more informed about testing. In an adjusted logistic regression model of session attendance, the strength of the parenting alliance was associated with a 6% increase in the likelihood of attending genetic counseling (odds ratio [OR]=1.06, 95% confidence interval [CI]=1.01, 1.12, p<.05) and greater perceived knowledge about BRCA1/2 testing was associated with a four-fold increase in the likelihood of session attendance (OR=4.03, CI=1.77, 9.37, p<.001).

CONCLUSION

One in three fathers attend pretest cancer genetic counseling with mothers undergoing BRCA1/2 testing; those who do have closer parenting relationships and are more informed about BRCA1/2 testing.

PRACTICE IMPLICATIONS

When possible, providers should discuss mothers including fathers in cancer genetic counseling sessions as this may affect outcomes of HBOC genetic counseling and testing.

Assessing the need for certainty in users of a clinical genetic health service

AIM

This paper presents a study investigating the need for closure in users of a genetic health service.

BACKGROUND

Genetic healthcare services are used by people who are concerned about a genetic condition in the family. Many clients expect information about the condition, risk assessment and discussion of options available to minimize the impact of the condition on the family. Some use the information to try to obtain certainty or cognitive closure. The psychological theory termed 'need for cognitive closure' explains individual differences in motivation to seek information. The tendency to seek closure can be measured by the Need for Closure Scale, which has five sub-scales: preference for order, preference for predictability, discomfort with ambiguity, decisiveness and closed-mindedness.

METHODS

Clients who were referred to our genetic service in 1998 were approached before personal contact with staff of the genetic service. Fifty-two people completed the need for closure scale questionnaire. Six months after the genetic consultation, participants were asked to complete the questionnaire again (n = 45). The data were statistically analysed using Cronbach's alpha, paired t-tests and independent t-tests.

RESULTS

There were no statistically significant differences in Need for Closure Scale scores in this cohort before and after the genetic consultation. Participants scored highly on the preference for order and discomfort with ambiguity sub-scales, but scores for closed-mindedness were low. Intolerance of ambiguity was statistically significantly higher in participants whose main concerns centred on their children.

CONCLUSIONS

This psychological theory can help healthcare professionals to understand the motivation of clients who seek information from genetic services, and enhance understanding of those who avoid using the service. It cannot be assumed that additional knowledge is helpful to all clients, nor that knowledge of bad news is necessarily an adverse event if prior uncertainty has existed.

Impact of an information booklet on satisfaction and decision-making about BRCA genetic testing

The aim of this study was to assess the impact of a standardized patient information booklet on decisions women make about genetic testing. This French national multi-centre survey included all women with cancer to whom genetic testing for BRCA1/2 mutation had been proposed. The control group was surveyed before the booklet became available (n = 263), and the experimental group, after being given it personally (n = 297). After multivariate adjustment, the booklet had a positive impact on satisfaction with the information provided (Odds ratio (OR) = 2.9; 99% confidence interval (CI) = 1.7-5.0; P = 0.001), decreased the decisional conflicts due to lack of information (OR = 1.9; 99% CI = 1.1-3.3; P = 0.002), and had a marginal impact on knowledge (R2-gain = 3%; P = 0.001). The women in the experimental group decided more frequently to undergo testing (99% vs. 95%; P = 0.009). In addition to a consultation providing more tailored information, a standardized written document improved the decision-making process involved in giving informed consent to genetic testing.