A systematic review of psycho‐social interventions for individuals with a BRCA1/2 pathogenic variant

Abstract

Women with a pathogenic variant in BRCA1/2 genes have up to an 87% lifetime risk of breast cancer and up to a 68% lifetime risk for ovarian cancer. Common riskreducing measures include prophylactic surgeries or pharmacological approaches, such as chemoprevention. Psycho-social issues can arise due to this increased risk, often resulting in heightened distress or anxiety. This review examines the efficacy of interventions aimed at improving psychological adjustment in individuals with a pathogenic variant in BRCA1/2. A Public and Patient Involvement (PPI) Panel of six individuals with a BRCA1/2 pathogenic variant provided input on the terminology used and dissemination of the review. Interventions assessing psychological measures in BRCA1/2 pathogenic variant carriers, published in English, were considered eligible for inclusion. A systematic search strategy was carried out on OVID, EBSCO, Cochrane Library, PubMed, Web of Science Core Collections, and Scopus. Two independent reviewers conducted screening, data extraction, risk of bias assessments, and theory coding. Findings were reported through narrative synthesis. Of the 1,024 results from searches, fifteen interventions were eligible. Nine of these were randomized controlled trials, six were quasi-experimental. There was heterogeneity in intervention design, with limited evidence of improvement upon psychological outcome measures.No study was rated as being low risk for bias. Five studies obtained the highest level of risk for bias, the majority of issues arising from problematic outcome measurement.No single study met all criteria on the Theory Coding Scheme, with five studies mentioning a theoretical aspect to intervention design, of which three employed a middlerange theory only. Some studies demonstrated a longitudinal impact on outcomes, however, there is insufficient evidence to draw broad conclusions from this. Further research is needed to better develop interventions to support those with a pathogenic variant in BRCA1/2 throughout their coping experience.

A qualitative reflexive thematic analysis into the experiences of being identified with a BRCA1/2 gene alteration: “So many little, little traumas could have been avoided”

“…There are avenues through which such support can be offered by the nursing profession to hereditary cancer cohorts. Psychoeducational interventions have been previously noted as efficacious in assisting in reducing anxiety in this cohort [26], and these can be tailored to ensure that the appropriate level of information is provided depending on what risk management service they are engaging with. As such, it is important to ensure that healthcare practitioners, such as nurses, are well-equipped to acknowledge and assist individuals in dealing with uncertainty.…”

“…", which was initially included in the interview guide. Further commentary on the input from PPI on language deemed acceptable for the BRCA 1/2 population has been detailed elsewhere [26].…”