Health beliefs associated with readiness for genetic counseling among high risk breast cancer survivors

Abstract

Purpose: Uptake of genetic counseling among breast cancer survivors is low. We used the Health Belief Model (HBM) to explore factors associated with readiness for genetic counseling among breast cancer survivors. Methods: Breast cancer survivors meeting NCCN genetic counseling referral criteria were recruited through clinics and community settings. Participants completed questionnaires capturing demographic and clinical information and factors guided by the HBM, including health beliefs, psychosocial variables, and cues to action. Using logistic regression, we examined whether the above variables differed based on readiness group (pre-contemplators, who did not plan to make a genetic counseling appointment, and contemplators, who planned to make a genetic counseling appointment in the next 1– 6 months). Results: Of 111 participants, 57% were pre-contemplators and 43% were contemplators. In the multivariable model, higher cancer worry was associated with increased odds of being a contemplator (OR=2.99; 95% CI=1.37–6.54) and higher perceived barriers to genetic counseling were associated with decreased odds of being a contemplator (OR=0.31; 95% CI= 0.11–0.85). Those who reported a family member encouraged them to get tested were more likely to be contemplators (OR=3.57; 95% CI=1.19– 10.70). Conclusions: Our results suggest key factors for predicting genetic counseling readiness include cancer worry, perceived barriers, and family influence. Implications for Cancer Survivors: Ideally genetic counseling occurs prior to treatment, but significant advantages exist for survivors. There is need for increased genetic counseling awareness. Better understanding of factors related to survivors’ decisions about counseling can inform tailored interventions to improve uptake and ultimately reduce cancer recurrence risk.

Development of a culturally sensitive narrative intervention to promote genetic counseling among African American women at risk for hereditary breast cancer

“…Our thematic findings are consistent with prior studies that show AA women experience a number of barriers that impact their use of genetic services, including provider referral and communication, 1,3,6,8,11,17,44 lack of awareness and access, 1,3,6,11,12,17,27,44‐49 risk perception, 3,48‐50 fear, and family concerns 27,43 . Importantly, many women in our study believed that if they attended the GC appointment they would be given a cancer diagnosis or told that they would definitely get cancer someday, which was tantamount to a death sentence in their minds.…”

A randomized controlled intervention to promote readiness to genetic counseling for breast cancer survivors

“…Baseline characteristics for the entire sample have been previously described. 18 The intervention (n=60) and control (n=59) groups differed on two psychosocial variables at baseline: knowledge score ( p =0.041) and IES avoidance subscale ( p =0.009) (Table 2). Therefore, these two variables were controlled for in the subsequent mixed models of the other variables with one exception: because avoidance is an IES subscale, it was not controlled for in the mixed model for IES total score.…”

“…The lack of PEI impact on perceived barriers and cancer worry is particularly notable, as prior work has identified perceived barriers and cancer worry as primary factors associated with women’s contemplation. 18 Given the implication that both worry and a lack of barriers may be important for behavior change, the absence of PEI effects on these variables may explain the fact that, in contrast with the movement of women in the intervention group through the Stages of Change towards GC, only 3 (3%) attended a GC appointment.…”

“…Recruitment is detailed elsewhere. 18 In brief, participants were recruited between March 2015 and September 2015 from: an institutional genetic referral database; flyers in BC waiting areas at our institution; survivorship support groups across the state of Florida; local email listservs; and a press release from our media team. This study received Insitutional Review Board approval (protocol #00005333).…”

Factors Influencing Discussion of Cancer Genetic Testing with Health-Care Providers in a Population-Based Survey

“…Exposure to factors that prompt action; belief that they can successfully perform the action to control the illness (self-efficacy); and psychosocial factors (e.g., worry) may also facilitate behavior change. HBM is well validated and has been shown to predict a broad variety of health behaviors including cancer prevention behaviors in genetics [13, 14]. Additionally, we enhanced the HBM with constructs known to influence health decision-making, such as information seeking and related beliefs [15].…”