Artikel 'Which factors predict proposal and uptake of psychological counselling after BRCA1/2 test result disclosure?' (2014)

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% CI1.1–2.7; 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.