Meiser Bettina, Halliday Jane L
Department of Psychological Medicine, Royal North Shore Hospital, St Leonard, NSW, Sydney, Australia.
Soc Sci Med. 2002 May;54(10):1463-70. doi: 10.1016/s0277-9536(01)00133-2.
Meta-analytic methods were used to determine the impact of genetic counselling on women with a family history of breast cancer. Published studies with prospective designs and randomized controlled trials were included in the review, and the psychological outcomes assessed were generalized psychological distress, generalized anxiety, depression, and breast cancer anxiety. Other outcomes investigated were the accuracy of perceived risk of developing breast cancer, breast cancer genetics knowledge and breast cancer screening uptake. A meta-analysis was performed to estimate effect size, where sufficient data were available. A total of 12 studies, most of which measured several outcomes, met at least one of the inclusion criteria. A sufficiently large number of studies were available to assess the magnitude of effects on three outcomes: generalized psychological distress, generalized anxiety and accuracy of perceived risk of developing breast cancer. The quantitative synthesis showed that genetic counselling leads to statistically significant decreases in generalized anxiety, with an average weighted effect sizes of r = - 0.17 (p<0.01). In contrast, the reduction in psychological distress exhibited a trend towards statistical significance only, with r = -0.074 (p = 0.052). The impact of genetic counselling on the accuracy of perceived risk was associated with an effect size of r = 0.56 (p<0.01). Thus in this meta-analysis, we demonstrated the efficacy of genetic counselling in meeting two of its objectives: reducing women's anxiety levels and improving the accuracy of their perceived risk. This review highlighted that most research so far focused on generalized distress and anxiety and accuracy of perceived risk, to the exclusion of other, perhaps equally important, types of outcomes. Future studies are likely to lead to more comprehensive assessments if additional emotional, cognitive and behavioural outcomes are included in the assessment.
采用荟萃分析方法来确定遗传咨询对有乳腺癌家族史女性的影响。纳入综述的已发表研究需具有前瞻性设计和随机对照试验，评估的心理结果包括一般性心理困扰、广泛性焦虑、抑郁和乳腺癌焦虑。研究的其他结果包括对患乳腺癌感知风险的准确性、乳腺癌遗传学知识以及乳腺癌筛查的接受情况。在有足够数据的情况下进行荟萃分析以估计效应量。共有12项研究符合至少一项纳入标准，其中大多数研究测量了多个结果。有足够数量的研究可用于评估对三个结果的影响程度：一般性心理困扰、广泛性焦虑以及对患乳腺癌感知风险的准确性。定量综合分析表明，遗传咨询能使广泛性焦虑在统计学上显著降低，平均加权效应量r = -0.17（p<0.01）。相比之下，心理困扰的降低仅呈现出统计学显著性趋势，r = -0.074（p = 0.052）。遗传咨询对感知风险准确性的影响效应量为r = 0.56（p<0.01）。因此，在这项荟萃分析中，我们证明了遗传咨询在实现其两个目标方面的有效性：降低女性的焦虑水平以及提高她们感知风险的准确性。该综述强调，迄今为止大多数研究都集中在一般性困扰、焦虑以及感知风险的准确性上，而排除了其他可能同样重要的结果类型。如果在评估中纳入更多的情绪、认知和行为结果，未来的研究可能会得出更全面的评估。
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