Green Michael J, Peterson Susan K, Baker Maria Wagner, Friedman Lois C, Harper Gregory R, Rubinstein Wendy S, Peters June A, Mauger David T
Department of Humanities, Penn State College of Medicine, Hershey, Pennsylvania 17033, USA.
Genet Med. 2005 Apr;7(4):221-9. doi: 10.1097/01.gim.0000159905.13125.86.
Patients seeking genetic testing for inherited breast cancer risk are typically educated by genetic counselors; however, the growing demand for cancer genetic testing will likely exceed the availability of counselors trained in this area. We compared the effectiveness of counseling alone versus counseling preceded by use of a computer-based decision aid among women referred to genetic counseling for a family or personal history of breast cancer.
We developed and evaluated an interactive computer program that educates women about breast cancer, heredity, and genetic testing. Between May 2000 and September 2002, women at six study sites were randomized into either: Counselor Group (n = 105), who received standard genetic counseling, or Computer Group (n = 106), who used the interactive computer program before counseling. Clients and counselors both evaluated the effectiveness of counseling sessions, and counselors completed additional measures for the Computer Group. Counselors also recorded the duration of each session.
Baseline characteristics did not differ significantly between groups. Participants and counselors both rated the counseling sessions as highly effective, whether or not the sessions were preceded by computer use. Computer use resulted in significantly shorter counseling sessions among women at low risk for carrying BRCA1/2 mutations. In approximately half of the sessions preceded by clients' computer use, counselors indicated that clients' use of the computer program affected the way they used the time, shifting the focus away from basic education toward personal risk and decision-making.
This study shows that the interactive computer program "Breast Cancer Risk and Genetic Testing" is a valuable adjunct to genetic counseling. Its use before counseling can shorten counseling sessions and allow counselors to focus more on the clients' individual risks and specific psychological concerns. As the demand for counseling services increases, a program such as this can play a valuable role in enhancing counseling efficiency.
寻求遗传性乳腺癌风险基因检测的患者通常由遗传咨询师进行指导；然而，对癌症基因检测不断增长的需求可能会超过该领域专业咨询师的供应。我们比较了单纯咨询与在咨询前使用基于计算机的决策辅助工具对因家族或个人乳腺癌病史而被转介进行遗传咨询的女性的效果。
我们开发并评估了一个交互式计算机程序，该程序可让女性了解乳腺癌、遗传和基因检测。在2000年5月至2002年9月期间，六个研究地点的女性被随机分为：咨询师组（n = 105），接受标准遗传咨询；或计算机组（n = 106），在咨询前使用交互式计算机程序。客户和咨询师都对咨询会议的效果进行了评估，咨询师还为计算机组完成了其他测评。咨询师还记录了每次会议的时长。
两组的基线特征无显著差异。无论会议前是否使用计算机，参与者和咨询师都将咨询会议评为非常有效。在携带BRCA1/2突变低风险的女性中，使用计算机导致咨询会议显著缩短。在大约一半客户使用计算机程序后的会议中，咨询师表示客户对计算机程序的使用影响了他们对时间的利用方式，将重点从基础教育转向了个人风险和决策。
本研究表明，交互式计算机程序“乳腺癌风险与基因检测”是遗传咨询的宝贵辅助工具。在咨询前使用该程序可以缩短咨询会议时长，并使咨询师能够更多地关注客户的个人风险和特定心理问题。随着对咨询服务需求的增加，这样的程序可以在提高咨询效率方面发挥重要作用。
