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Genet Med. 2017 Apr;19(4):448-456. doi: 10.1038/gim.2016.130. Epub 2016 Sep 29.

Streamlined genetic education is effective in preparing women newly diagnosed with breast cancer for decision making about treatment-focused genetic testing: a randomized controlled noninferiority trial.

Author information

1
Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia.
2
Familial Cancer Service, Westmead Hospital, Westmead, Australia.
3
Centre for Cancer Research, The Westmead Institute for Medical Research, University of Sydney, Westmead, Australia.
4
Department of Medical Oncology, Hereditary Cancer Clinic, Prince of Wales Hospital, Randwick, Australia.
5
Department of Obstetrics & Gynaecology, Royal Women's Hospital, University of Melbourne, Parkville, Australia.
6
School of Surgery, University of Western Australia, Crawley, Australia.
7
School of Population Health, University of Western Australia, Crawley, Australia.
8
Hunter Family Cancer Service, Waratah, Australia.
9
Sydney Medical School-Northern, University of Sydney, Sydney, Australia.
10
Royal North Shore Hospital, St Leonards, Australia.
11
Monash Health, Melbourne, Australia.
12
Familial Cancer Centre, Cabrini Health, Melbourne, Australia.
13
Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, Australia.
14
Genetic Health Queensland, Nambour General Hospital, Queensland, Australia.
15
School of Psychology, University of Sydney, Sydney, Australia.
16
Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia.

Abstract

PURPOSE:

Increasingly, women newly diagnosed with breast cancer are being offered treatment-focused genetic testing (TFGT). As the demand for TFGT increases, streamlined methods of genetic education are needed.

METHODS:

In this noninferiority trial, women aged <50 years with either a strong family history (FH+) or other features suggestive of a germ-line mutation (FH-) were randomized before definitive breast cancer surgery to receive TFGT education either as brief written materials (intervention group (IG)) or during a genetic counseling session at a familial cancer clinic (usual-care group (UCG)). Women completed self-report questionnaires at four time points over 12 months.

RESULTS:

A total of 135 women were included in the analysis, all of whom opted for TFGT. Decisional conflict about TFGT choice (primary outcome) was not inferior in the IG compared with the UCG (noninferiority margin of -10; mean difference = 2.45; 95% confidence interval -2.87-7.76; P = 0.36). Costs per woman counseled in the IG were significantly lower (AUD$89) compared with the UCG (AUD$173; t(115) = 6.02; P < 0.001).

CONCLUSION:

A streamlined model of educating women newly diagnosed with breast cancer about TFGT seems to be a cost-effective way of delivering education while ensuring that women feel informed and supported in their decision making, thus freeing resources for other women to access TFGT.Genet Med 19 4, 448-456.

PMID:
27684037
DOI:
10.1038/gim.2016.130
[Indexed for MEDLINE]

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