Knowledge and psychosocial impact of genetic counseling and multigene panel testing among individuals with ovarian cancer

Abstract

In a sample of individuals with ovarian cancer, we aimed to (a) identify factors associated with the psychosocial impact of genetic counseling and multigene panel testing, (b) identify factors associated with cancer genetics knowledge, and (c) summarize patient-reported recommendations to improve the genetic counseling and multigene panel testing process. Eligible participants in this secondary analysis of quantitative and qualitative survey data were English-speaking adults with ovarian cancer. Psychosocial impact was assessed using the Multidimensional Impact of Cancer Risk Assessment (MICRA) questionnaire. Knowledge of cancer genetics was assessed using the KnowGene scale. Significant predictors of MICRA and KnowGene scores were identified using multiple regression. Open-ended survey item responses were analyzed using conventional content analysis. Eighty-seven participants met eligibility criteria. A positive genetic test result was associated with greater adverse psychosocial impact (B = 1.13, p = 0.002). Older age (B = − 0.07, p = 0.044) and being a member of a minority racial or ethnic group (B = − 3.075, p = 0.033) were associated with lower knowledge, while a personal history of at least one other type of cancer (B = 1.975, p = 0.015) was associated with higher knowledge. In open-ended item responses, participants wanted clinicians to assist with family communication, improve result disclosure, and enhance patient and family understanding of results. A subset of individuals with ovarian cancer who receive a positive genetic test result may be at risk for adverse psychosocial outcomes. Tailored cancer genetics education is necessary to promote the equitable uptake of targeted ovarian cancer treatment and risk-reducing therapies. Interventions to enhance patient-clinician communication in this setting are a research priority.

Patient‐reported outcomes associated with reflex BRCA1/2 tumor and subsequent germline panel genetic testing for high‐grade serous ovarian cancer

“…In contrast to cancer-related distress, a significant reduction in genetic testing-related distress was noted from disclosure of research, establishing relevant cut-offs for this tool is an important area for further study. Of note, despite decreases in the average MICRA scores among our cohort, scores remained higher than those previously published among individuals with ovarian cancer following germline genetic testing (mean MICRA scores: 17.7-20) (Bjornslett et al, 2015;Pozzar et al, 2022;Richardson et al, 2020).…”

“…They are also more likely to have young children, which could contribute to initial uncertainty and genetic testing‐related distress. It is not surprising that individuals in our cohort who received only negative genetic testing results had lower levels of genetic testing‐related distress, as receiving a positive genetic test result is associated with increased genetic testing‐related distress (Bjornslett et al, 2015; Pozzar et al, 2022; Richardson et al, 2020). While the number of individuals in this study is too small to make meaningful conclusions, it is interesting to note that individuals who received positive tumor and negative germline results had a very large reduction in genetic testing‐related distress from disclosure of tumor to germline results.…”

“…Additional qualitative studies to glean participant perspectives may provide more context to the relatively high MICRA scores seen in our cohort; however, they may be related to consistently high levels of cancer-related distress, as cancer-related distress has been associated with genetic testing-related distress (McCuaig et al, 2022). (Bjornslett et al, 2015;Pozzar et al, 2022;Richardson et al, 2020). While the number of individuals in this study is too small to make meaningful conclusions, it is interesting to note that individuals who received positive tumor itive results have germline testing) models of care.…”

Psychosocial impact of proactive rapid genetic counseling following breast cancer diagnosis

“…While the increased complexity and uncertainty associated with multigene testing could adversely impact patient responses to genetic counseling, initial studies on outcomes of multigene counseling and testing have reported comparable outcomes to traditional single gene counseling and testing. [34][35][36] The expansion of genetic referral guidelines and concomitant increased demand, have fostered alternative approaches to pre-test genetic counseling. 37 While our study incorporated telephonebased genetic counseling, the impact of more recent technologybased approaches (e.g., chatbots), physician-delivered counseling, and post-test only counseling remain to be evaluated.…”

“…Multigene genetic counseling must also address the increased likelihood of detecting a variant of uncertain clinical significance. While the increased complexity and uncertainty associated with multigene testing could adversely impact patient responses to genetic counseling, initial studies on outcomes of multigene counseling and testing have reported comparable outcomes to traditional single gene counseling and testing 34‐36 …”