Is It Feasible? Self-Affirmation for Hereditary Breast and Ovarian Cancer Genetic Counseling

Background: In recent years there has been increased understanding of the genetic factors that predispose people to cancer. While this increase in knowledge can improve patient health, patients, who are at increased risk for cancer, face decisions about testing, cancer screening, communication with family members, and even prophylactic surgery. Statement of problem: As more people face these decisions it is important for genetic counselors to support them in the decision-making process. Self-affirmation interventions may be an effective way to improve hereditary breast and ovarian cancer (HBOC) genetic counseling patient-centered outcomes. The study described is a randomized controlled trial to assess the feasibility of implementing a SA intervention in a cancer genetic counseling clinic. Methods: This study was conducted in a hereditary cancer clinic at St. Luke’s Health System in Kansas City, Missouri. Patients who attended the clinic for a genetic counseling session, were randomized to completed a SA intervention or a control writing exercise beforehand and a survey of patient-centered outcomes afterward. Counselors completed a patient empowerment assessment after each appointment. The primary feasibility outcomes were patient acceptance of the SA intervention, patient attrition, and the effectiveness of the SA intervention. Secondary outcomes were: decision self-efficacy, intentions to talk with family, genetic test uptake, patient empowerment, and HBOC knowledge. Results: All patient participants reported that the intervention did not interfere with their appointment (35/35). Coding analysis of patient essays showed that those who were in the intervention group were significantly more affirmed than those in the control group (p <= 0.01). None of the secondary outcomes were statistically significantly different between the control and intervention groups. Patient and counselor scores on the empowerment measure were not significantly correlated (p = 0.298). Conclusions: Given our findings, follow-up studies, such as a phase II study is needed to enhance our understanding of SAs usefulness in buffering patients from the threat of cancer. Future studies should include more diverse populations and if SA is effective in the cancer setting, additional studies in other subspecialties of genetic counseling will be important prior to generalizing evidence across specialties