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. 2015 Oct;38(5):740-53.
doi: 10.1007/s10865-015-9648-z. Epub 2015 Jul 16.

Genetic test reporting enhances understanding of risk information and acceptance of prevention recommendations compared to family history-based counseling alone

Jennifer M Taber  1 , Lisa G Aspinwall  2 , Tammy K Stump  1 , Wendy Kohlmann  3 , Marjan Champine  3 , Sancy A Leachman  4
Affiliations

Genetic test reporting enhances understanding of risk information and acceptance of prevention recommendations compared to family history-based counseling alone

Jennifer M Taber et al. J Behav Med. 2015 Oct.

Abstract

It is unknown whether or why genetic test reporting confers benefits in the understanding and management of cancer risk beyond what patients learn from counseling based on family history. A prospective nonexperimental control group study compared participants from melanoma-prone families who underwent CDKN2A/p16 (p16) genetic testing (27 carriers, 38 noncarriers) to participants from equivalently melanoma-prone families known not to carry a deleterious p16 mutation (31 no-test controls). All participants received equivalent counseling concerning elevated lifetime melanoma risk and corresponding recommendations for prevention and screening. Both immediately and 1 month after counseling, participants receiving a genetic test result reported greater understanding of their risk, decreased derogation of the risk information, and greater personal applicability of prevention recommendations than no-test controls. Decreased derogation of risk information after test reporting predicted further increases in understanding of melanoma risk and applicability of prevention recommendations 1 month later. Results suggest unique benefits of genetic test reporting in promoting understanding and acceptance of information about hereditary cancer risk and its management.

Keywords: CDKN2A/p16; Defensive processing; Genetic testing; Illness coherence; Melanoma; Understanding of risk.

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Conflict of interest statement

Conflict of Interest:

Dr. Taber, Ms. Stump, Ms. Kohlmann, and Ms. Champine declare that they have no conflict of interest. Dr. Aspinwall’s work is funded by the NIH. Dr. Leachman’s work is funded by the NIH. Dr. Leachman serves on a Medical and Scientific Advisory Board for Myriad Genetics Laboratory, for which she has received an honorarium. She has collaborated with Myriad on a project to validate an assay that is unrelated to the research reported here.

Figures

Figure 1
Figure 1
Participant identification, recruitment and retention for the first three study visits that were completed by participants from March to mid-October of 2012 and 2013.
Figure 2
Figure 2
Outline of study procedure through three visits in the first year of participation, including key points of information from the genetic counseling protocol and selected information about the content of surveys at each assessment.
Figure 3
Figure 3
Figure 3A. Increases from baseline in melanoma coherence immediately following counseling and at the 1-month follow-up among no-test controls, p16 carriers, and p16 noncarriers Figure 3B. Increases from baseline in understanding of melanoma risk immediately following counseling and at the 1-month follow-up among no-test controls, p16 carriers, and p16 noncarriers Note: Bars with different superscripts indicate significant differences across Time of Assessment in each group, p<.05 * Denotes significant differences between groups, p<.05
Figure 4
Figure 4
Derogation of risk information and acceptance of prevention recommendations as a function of counseling and test reporting (p16 carriers and noncarriers) versus counseling based on family history alone (no-test controls), averaged across time of assessment (post-counseling and 1-month follow-up) Notes: Degrees of freedom for main effect of Group are 2,94. Bars with different superscripts indicate significant differences between groups, p<.05
Figure 5
Figure 5
Model of the cross-lagged relations among understanding of risk, derogation of risk information, and personal applicability of behavioral recommendations immediately following and one month after genetic counseling plus test reporting (p16 carriers) or counseling based on family history alone (no-test controls). Note: Correlations among measures within visits were included in the model, but omitted from the figure for ease of presentation. All but one such association were significant at p<.05: understanding of risk information and perceived applicability of prevention recommendations were not significantly correlated at one month. Significant pathways are indicated by solid lines and nonsignificant pathways are indicated by dashed lines. Path coefficients are unstandardized beta coefficients with standard errors in parentheses. **p<.01, *p<.05, ^p<.10
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References

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