An interactive computer program can effectively educate patients about genetic testing for breast cancer susceptibility

Abstract

As genetic testing for susceptibility to breast cancer becomes more widespread, alternative methods for educating individuals prior to testing will be needed. Our objective was to compare face-to-face education and counseling by a genetic counselor with education by an interactive computer program, assessing the effects of each on knowledge of breast cancer genetics and intent to undergo genetic testing. We used a randomized, controlled trial. Seventy-two self-referred women with a first-degree relative with breast cancer received outpatient education and counseling at the Clinical Center of the National Institutes of Health (NIH). Twenty-nine received individualized counseling from a genetic counselor (counseling group), 29 received education from an interactive computer program followed by individualized counseling (computer group), and 14 were controls. Both pre- and postintervention assessment of knowledge about breast cancer genetics and intent to undergo genetic testing were measured. The control group participants correctly answered 74% of the knowledge questions; the counselor group, 92%; and the computer group, 96% (P <.0001). Unadjusted mean knowledge scores were significantly higher in the computer group than the counselor group (P =.048), but they were equivalent when adjusted for demographic differences (P = 0.34). Intent to undergo genetic testing was influenced by the interventions: preintervention, a majority in all groups (69%) indicated that they were likely (definitely and most likely) to undergo testing; after either intervention coupled with counseling, only 44% indicated that they were likely to do so (P =.0002; odds ratio = 2.8, 95% CI = 1.7-4.9). We concluded that a computer program can successfully educate patients about breast cancer susceptibility, and, along with genetic counseling, can influence patients' intentions to undergo genetic testing.

Impact of a patient decision aid on care among patients with nonvalvular atrial fibrillation: a cluster randomized trial

“…For example, all 9 trials evaluating knowledge have shown that decision aids significantly improve patient knowledge, with a weighted mean difference of 19% (compared with 16% in this trial). 8,[12][13][14][15][16][17][18][19][20] Similarly, all 6 of the trials that examined decisional conflict reported statistically significant improvements with decision aids of magnitudes virtually identical to our results. 17,18,[21][22][23][24] However, decision aids have had variable impacts on management in the 3 tri- als evaluating medical therapies: one 24 reported a 76% increase in hepatitis B vaccination with a decision aid, another 25 reported a nonsignificant 8% reduction in hormone replacement use, and the third 17 reported a nonsignificant 6% increase in ASA use among patients with NVAF at low risk of stroke.…”

Decision Coaching to Prepare Patients for Making Health Decisions

“…[13][14][15][16] The included trials were conducted in 4 countries and published between 1997 and 2009 (see Table 1). The trials focused on decisions related to: hormone replacement therapy, 17,18 breast cancer genetic testing 19,20 and treatment, 21 prostate cancer screening 22 and treatment, 23 prenatal testing, 24 schizophrenia treatment, 25 and menorrhagia treatment. 26 The mean number of participants per trial was 242 (range 43-625).…”

Use of an educational computer program before genetic counseling for breast cancer susceptibility: Effects on duration and content of counseling sessions

“…29 Subsequently, we revised and updated the computer program and conducted a larger, randomized, multicenter trial among women referred for genetic counseling due to family or personal histories of breast cancer. 30 In this article, we report findings from one aspect of that study that compared the effectiveness of counseling alone with counseling preceded by computer use.…”