The relationship between perceived risk, thought intrusiveness and emotional well‐being in women receiving counselling for breast cancer risk in a family history clinic

Abstract

Objectives. This study was designed to assess changes in perceived risk, cognitive intrusions and distress in women undergoing counselling for familial risk of developing breast cancer. Design. A longitudinal design in which 90 consecutive women attending a family history clinic were asked to indicate their concerns before counselling and then again 3 and 6 months post‐counselling. Method. Questionnaires included measures of thought content and intrusiveness, cancer specific distress (Cockburn, De Luise, Hurley, & Clover, 1992), a Visual Analogue scale (VAS) of perceived risk, and the Hospital Anxiety and Depression (HAD) scale (Zigmond & Snaith, 1983). Results. Sixty‐nine women agreed to take part in the study, with 49 completing all three sets of questionnaires. Before counselling, thought intrusiveness and HAD depression scores accounted for 69% of the variance in the measure of cancer specific distress. Women who dropped out of the study before the post‐counselling assessments reported higher levels of intrusiveness at baseline than those who completed the study. Perceived risk was only moderately related to actual risk post‐counselling and increases/ decreases in thought intrusiveness correlated positively with increases/decreases in both perceived risk and distress. Conclusions. Psychological distress is related to levels of perceived risk, a relationship which may be mediated by thought intrusiveness. It could be more appropriate for genetic counselling services to provide strategies for managing intrusiveness of worries rather than attempting to modify risk perceptions.

Changes in psychological distress after cancer genetic counselling: a comparison of affected and unaffected women

“…These mean HADS scores are comparable to those found in other studies of women undergoing genetic counselling for breast/ovarian cancer risk (e.g. DudokdeWit et al, 1998;Kent et al, 2000;Lodder et al, 1999) and for women undergoing routine breast screening (Walker et al, 1994). Mean GHQ-28 scores were 21.2 (s.d.…”

“…Some of the few prospective studies that have examined how genetic counselling may influence levels of distress have found that general distress (Cull et al, 1999;Brain et al, 2000b) and cancer specific worry (Brain et al, 2000b;Kent et al, 2000) reduce following counselling, although others found no change (Watson et al, 1999). However, the group in the study by Watson et al (1999) were not split on the basis of their actual risk of developing cancer which may be likely to influence level of worry.…”

A Systematic Review of the Impact of Genetic Counseling on Risk Perception Accuracy

“…In contrast, the studies that did not mention giving counselees this information observed no significant improvement of risk perception accuracy as a result of genetic counseling (Codori et al 2005;Kent et al 2000;Rothemund et al 2001), with the exception of one study (Kaiser et al 2004).…”

A randomized trial of specialist genetic assessment: psychological impact on women at different levels of familial breast cancer risk

“…The current findings suggest that in women at lower risk, anxiety and cancer-related concerns were reduced after receiving personal risk information and there were high levels of satisfaction, regardless of whether this information was based on a detailed genetic analysis. Although some studies have shown no effect of providing risk information on psychological outcomes (Kent et al, 2000;Lloyd et al, 1996), this may reflect differences in the way that risk information is communicated. Improved psychological outcomes may be a function of services that not only provide specific risk information, but also address patients' emotional needs by offering appropriate reassurance (Watson et al, 1998).…”