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. 2022 Dec 9;10(1):1190-1215.
doi: 10.1080/21642850.2022.2150623. eCollection 2022.

Understanding cancer genetic risk assessment motivations in a remote tailored risk communication and navigation intervention randomized controlled trial

Circe Gray Le Compte  1 , Shou-En Lu  2 , Julianne Ani  1 , Jean McDougall  3 , Scott T Walters  4 , Deborah Toppmeyer  5 , Tawny W Boyce  6 , Antoinette Stroup  7 , Lisa Paddock  8 , Sherry Grumet  9 , Yong Lin  10 , Emily Heidt  1 , Anita Y Kinney  10
Affiliations

Understanding cancer genetic risk assessment motivations in a remote tailored risk communication and navigation intervention randomized controlled trial

Circe Gray Le Compte et al. Health Psychol Behav Med. .

Abstract

Background: National guidelines recommend cancer genetic risk assessment (CGRA) (i.e. genetic counseling prior to genetic testing) for women at increased risk for hereditary breast and ovarian cancer (HBOC). Less than one-half of eligible women obtain CGRA, leaving thousands of women and their family members without access to potentially life-saving cancer prevention interventions.

Purpose: The Genetic Risk Assessment for Cancer Education and Empowerment Project (GRACE) addressed this translational gap, testing the efficacy of a tailored counseling and navigation (TCN) intervention vs. a targeted print brochure vs. usual care on CGRA intentions. Selected behavioral variables were theorized to mediate CGRA intentions.

Methods: Breast and ovarian cancer survivors meeting criteria for guideline-based CGRA were recruited from three state cancer registries (N = 654), completed a baseline survey, and were randomized. TCN and targeted print arms received the brochure; TCN also participated in a tailored, telephone-based decision coaching and navigation session grounded in the Extended Parallel Process Model and Ottawa Decision Support Framework. Participants completed a one-month assessment. Logistic regression was used to compare the rate of CGRA intentions. CGRA intentions and theorized mediator scores (continuous level variables) were calculated using mixed model analysis.

Results: CGRA intentions increased for TCN (53.2%) vs. targeted print (26.7%) (OR = 3.129; 95% CI: 2.028, 4.827, p < .0001) and TCN vs. usual care (23.1%) (OR = 3.778, CI: 2.422, 5.894, p < .0001). Perceived risk (p = 0.023) and self-efficacy (p = 0.035) mediated CGRA intentions in TCN.

Conclusions: Improvements in CGRA intentions and theorized mediators support the use of a tailored communication intervention among women at increased HBOC risk. (Clinicaltrials.gov: NCT03326713.)Trial registration: ClinicalTrials.gov identifier: NCT03326713.

Keywords: Genetic testing; cancer; genetic counseling; hereditary breast and ovarian cancer.

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Conflict of interest statement

No potential conflict of interest was reported by the author(s).

Figures

Figure 1.
Figure 1.
Mediation analysis models: theorized mediators of GRACE interventions on intentions to seek CGRA.
Figure 2.
Figure 2.
CONSORT diagram of the GRACE project randomized-control trial from baseline to the one-month follow-up. Note: * In the intent-to-treat analysis, only participants found ineligible were excluded.
Figure 3.
Figure 3.
Single mediation analysis, indirect effects of theorized mediators on TCN, baseline to the one-month follow-up. Notes: Figure 3 illustrates direct and indirect mediation effects of the theorized mediation variables on TCN. Two variables, perceived susceptibility and self-efficacy significantly mediated the relationship between TCN and CGRA intentions. *p < 0.05, **p < 0.01, ***p < 0.001.
See this image and copyright information in PMC

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