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Table 6Types of Genetic Counseling Provided in Included Studies

Author, yearSettingProvider of genetic counselingComponents of genetic counseling
Current report
Armstrong et al, 2005148Not reportedNot reportedGenetic counseling not specified.
Bennett et al, 2008150Cancer Genetics Service CenterGenetic counselorWomen with family history of breast/ovarian cancer referred by general practitioner or other medical specialists into the service. After assessment of information in family health questionnaire by genetic specialists, individual genetic risk of developing familial breast and ovarian cancer was calculated as a percentage of lifetime risk and stratified into high, moderate, and population risk levels. Women considered high risk for breast/ovarian cancer were offered counseling, genetic testing, and annual mammography; woman at moderate risk were offered annual mammography.
Bennett et al, 2009149Cancer Genetics Service CenterGenetic counselorSee Bennett 2008.
Bloom et al, 2006151Telephone counselingMaster's level counselorTelephone counseling session included: establishment of rapport and determination of special concerns, emotional readiness, risk notification by providing modified Gail model lifetime risk estimate and discussing in terms of pretest self-assessment of risk, deescalation of tension regarding breast cancer checkup, evaluation of coping skills, reinforcement of problem solving and coping skills, information on health protective behaviors, early detection through American Cancer Society screening, and information on genetic testing when requested.
Bowen et al, 2006152UniversityPsychologist, genetic counselorGroup psychological counseling: Psychologist led four 2-hour, weekly sessions of 5 to 6 women per group, with each session including a 20-min group cohesion activity followed by 1 of 4 major intervention components: risk assessment and perception, education, stress management, and problem solving and social support.
Individual genetic counseling: Genetic counselor provided 1-hour counseling sessions and sessions covered several topics, including participant's family background, breast cancer risk assessment, BRCA1 and BRCA2 mutations in the Ashkenazi Jewish population, nongenetic risk factors for breast cancer, and breast screening.
Brain et al, 2011153Not reportedClinicianWomen with a family history of breast cancer receive a specialist genetic assessment service. Control group received general risk level (low/population, moderate, or high) based on age, reproductive history, and minimal family history; intervention group received a specific percentage based on Claus model based on detailed family pedigree; genetic testing was available to women in intervention group at high risk (≥25% risk).
Braithwaite et al, 2005154Not reportedClinical nurse specialistRisk counseling: Received pedigree with information from family history and assessed risk as low, moderate, or high based on GRACE guidelines; participants were mailed letters summarizing content afterward.
GRACE: Completed pedigrees in GRACE and assessed their risk, learning their risk assessment and how to manage their risk; received a numerical estimate of lifetime risk, a visual display of cumulative risk with general population as comparator, and a qualitative description; clinical nurse specialists then offered to book mammography and arrange meetings with geneticists, where appropriate.
Fry et al, 2003155Familial Breast Cancer ClinicGenetics consultant and specialist breast surgeon; geneticist and genetics nurse specialistStandard (regional) service: Self-report family history and baseline questionnaire completed by all women; genetics consultant and genetics nurse specialist assigned categorical risk via Cancer Research Campaign. Women at low risk received a letter; women at moderate or high risk were offered an appointment at familiar breast cancer clinic where a genetics consultant discussed risk status and breast surgeon discussed risk management. Where appropriate, clinical exams and mammography were included in the appointment. Patients' general practitioners received summary data, and patients received followup questionnaires 4 weeks and 6 months later.
Novel (community-based) service: All women sent an appointment for a community-based clinic near their residence. Meetings run by genetics nurse specialist where family history collected and compared to published criteria (Cancer Research Campaign) to determine risk. Women at low risk offered information, reassurance, and discharged. Women at increased risk (moderate or high) were offered an appointment at a regional center with a geneticist and genetics nurse specialist, and asked to complete followup questionnaires at 4 weeks and 6 months.
Gurmankin et al, 2005156University breast and ovarian cancer risk evaluation programHealth care providerPrecounseling interview: Assessed patient's breast cancer risk perception, BRCA mutation risk perception, worry about breast cancer, family history of cancer, breast cancer risk reduction behaviors, and demographic information.
Postcounseling interview: Assessed patient's breast cancer risk, BRCA mutation risk, recall of actual risk information, and worry about breast cancer.
Helmes et al, 2006157Not reportedBoard certified genetic counselorIn-person counseling: Review of family history, discussion of breast cancer risk, and education about breast cancer genes; discussed genetic testing considerations, including implications of results, testing strategies, potential risks and benefits of test, costs and psychological effects of test; gave information packet with personal risk information comparing woman's risk with average woman's risk, personal computer-drawn 3-generation pedigree, brochures on self-breast exams, Pap test, and mammography; genetics visual aids, and list of community resources.
Telephone counseling: Information packet was sent in the mail with instructions to open at the beginning of the telephone counseling, which was identical in content and structure to in-person counseling.
Hopwood et al, 2004158Cancer genetic service centersGenetic counselorGenetic counseling prior to testing varied by participating center, but offered or recommended some of the following: risk estimation (based on molecular genetic analysis or more often on family history), genetic risk counseling, clinical exam, screening/surveillance for early tumor detection (mammography, endoscopy), information on preventive strategies (surgery, diet), family planning advice, and referral for psychological assessment/support.
Kelly et al, 2008159Not reportedGenetic counselorReview of family cancer history, personal risk factors for breast and ovarian cancer, mechanisms of cancer inheritance, meaning of a positive and negative test result, and risks and benefits associated with testing.
Matloff et al, 2006160Not reportedCertified genetic counselorPersonalized letter summarizing patient data.
Mikkelsen et al, 2007161University clinical departmentsPhysiciansInformation on incidence of sporadic breast cancer, genetics, inheritance patterns, and estimated personal lifetime risk of inherited cancer.
Mikkelsen et al, 2009162University clinical departmentsPhysiciansInformation on incidence of sporadic breast cancer, genetics, inheritance patterns, and estimated personal lifetime risk of inherited cancer.
Pieterse et al, 2011163Department of medical geneticsClinical geneticists, residents in clinical genetics, genetic counselorsSession topics included family's occurrence of breast and other cancers, inheritance, and criteria on probability of inherited breast cancer, and the likelihood of hereditary breast cancer running in the family was estimated.
Roshanai et al, 2009164University cancer genetic clinicSpecialist nurseIncluded pedigree explanation, Buckman's Breaking Bad News model to inform at-risk relatives, pamphlet, videotape, copies of pedigree, and medical records.
Prior report
Bowen et al, 200257Not reportedGenetic counselor or trained health counselorIndividual genetic counseling: Telephone contact with genetic counselor to review pedigree information and one 2-hour session following protocol based on standard genetic practice, with a letter sent to participant within 2 weeks summarizing the session.
Group psychosocial counseling: Group of 4–6 participants met for four 2-hour sessions with trained health counselor, participants received risk assessment sheet, personalizing the group discussion to her own risk status, main topics: risk assessment, perception, screening, stress management and problem solving, social support.
Bowen et al, 200462Not reportedGenetic counselor or trained health counselorIndividual genetic counseling: Telephone contact with genetic counselor to review pedigree information and one 2-hour session following protocol based on standard genetic practice, with a letter sent to participant within 2 weeks summarizing the session.
Group psychosocial counseling: Group of 4–6 participants met for four 2-hour sessions with trained health counselor, participants received risk assessment sheet, personalizing the group discussion to her own risk status, main topics: risk assessment, perception, screening, stress management and problem solving, social support.
Brain et al, 2002166Not reportedClinical geneticist and genetic nurse specialistBreast cancer surveillance, option to enter UK Tamoxifen Prevention Trial, annual surgical followup with surveillance and advice, genetic risk assessment and counseling.
Burke et al, 200058UnclearGenetic counselorAdapted genetic counseling protocol for women with intermediate risk included precounseling telephone call gathering a complete family history, in-person genetic counseling session discussing breast cancer risk factors, focusing on issues relevant to the participant, reviewed pedigree information, communicated likelihood of mutation in participant's family, risk estimate sheet given to participant based on the Gail and Claus models and National Cancer Institute statistics for average risk, information about genetic testing, recommendations for breast cancer screening, and a followup letter summarizing the genetic counseling session.
Cull et al, 199859Breast cancer family clinicGeneticist and breast surgeonIndividual meeting with geneticist to discuss individual risk and with breast surgeon to discuss risk management, participants either received a copy of the educational video about 10 days before the clinic consultation or took the video home after the postclinic assessment.
Hopwood et al, 1998167Family history clinicsUnclearFamily history consultation, not otherwise described.
Lerman et al, 1996168Comprehensive cancer centersGenetic counselorDiscussion of individual factors contributing to elevated risk, presentation of individualized risk data, recommendations for annual mammography and clinical breast exams, and instruction in breast self-exam.
Lerman et al, 199960Hospital and cancer centerOncology nurses or genetic counselorEducation only: Topics discussed included individual risk factors for breast and ovarian cancer and patterns of inheritance for breast and ovarian cancer susceptibility, subjects given qualitative estimates of risk of developing breast and ovarian cancer, and pedigrees reviewed, potential benefits, limitations, and risks of genetic testing for inherited breast and ovarian cancer susceptibility reviewed.
Education plus counseling: Provided the same education and materials described above and subjects were guided through questions exploring personal issues related to cancer and genetic testing, discussed the emotional impact of having a family history of cancer, psychosocial implications of genetic testing for inherited breast and ovarian cancer susceptibility, anticipated reactions to positive and negative test result, and intentions to communicate test results to family members and friends.
Lobb et al, 2004169Not reportedClinical geneticists, oncologist, genetic counselorsCounselors provided counseling at their discretion and study was to assess the different aspects of counseling, which included information giving concerning: breast cancer genetics, genetic testing, family history and risk, prophylactic surgery, breast cancer prevention, screening and management; communication style including: facilitating patient involvement, facilitating understanding, patient centeredness and partnership building, and supportive and counseling communications.
Watson et al, 1998171HospitalsClinical geneticistConsultation provided information on pedigree based on risk calculation and information regarding management options based on risk level, with instructions offered on self-exam and clinical exam, with the intervention group also receiving an audiotape of the consultation to take home.
Watson et al, 1999172Genetic counseling centersClinical geneticistsNot described.

From: 3, RESULTS

Cover of Risk Assessment, Genetic Counseling, and Genetic Testing for BRCA-Related Cancer
Risk Assessment, Genetic Counseling, and Genetic Testing for BRCA-Related Cancer: Systematic Review to Update the U.S. Preventive Services Task Force Recommendation [Internet].
Evidence Syntheses, No. 101.
Nelson HD, Fu R, Goddard K, et al.

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