Department of Clinical Genetics, Center for Human and Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands.
Genet Med. 2011 Sep;13(9):800-11. doi: 10.1097/GIM.0b013e31821a36f9.
Genetic counseling may help counselees understand their genetic risk of developing breast/ovarian cancer. However, many studies have shown that their perception of their risks is inaccurate. Information-oriented variables often predicted the level of accuracy, focusing on specific processes of receiving and processing risks. We examined counselee-oriented predictors about how counselees embed cancer risks in their lives. These predictors reflect the personal meaning of genetic risks and are expected to explain/mediate the impact of genetic counseling on risk-perception-accuracy.
We analyzed 248 questionnaires of a prospective study, filled in by probands with breast/ovarian cancer and pathogenic mutations, unclassified variants, or uninformative results (n = 30, 16, and 202, respectively). Mediation regression analyses were performed to examine whether counselee predictors mediated/explained the influence of information predictors on the accuracy. Information-oriented predictors regarded presentation format, communicated information, question format, education, pedigree information, cancer experience, and cognitive processes/heuristics. Counselee-oriented predictors regarded their self/personality, life/existence, and need for certainty about DNA test result, heredity, and cancer.
Both information-oriented and counselee-oriented variables significantly predicted the accuracy of the counselees' risk perception, with moderate to large effect sizes. Counselee-oriented variables completely mediated/explained the effects of information-oriented variables on the accuracy.
Counselees seemed to transform objective cancer risks into personally relevant information. Only through this personal meaning of genetic information, information-oriented processes seemed to cause inaccurate perceptions. Genetic counselors are suggested to focus communication on these personal processes.
遗传咨询可以帮助咨询者了解其患乳腺癌/卵巢癌的遗传风险。然而，许多研究表明，他们对自己风险的感知并不准确。信息导向的变量通常可以预测准确性的水平，重点是接收和处理风险的具体过程。我们考察了咨询者导向的预测因子，这些预测因子反映了癌症风险在他们生活中的个人意义，并有望解释/调解遗传咨询对风险感知准确性的影响。
我们分析了一项前瞻性研究的 248 份问卷，由携带乳腺癌/卵巢癌和致病性突变、未分类变异或无信息结果的先证者填写（分别为 30、16 和 202 例）。进行中介回归分析，以检验信息预测因子是否对风险感知准确性的影响有中介/解释作用。信息导向的预测因子包括呈现格式、传达的信息、问题格式、教育、家族史信息、癌症经历和认知过程/启发式。咨询者导向的预测因子包括他们的自我/个性、生活/存在以及对 DNA 测试结果、遗传和癌症的确定性需求。
信息导向和咨询者导向的变量都显著预测了咨询者风险感知的准确性，具有中等至较大的效应大小。咨询者导向的变量完全中介/解释了信息导向变量对准确性的影响。
咨询者似乎将客观的癌症风险转化为个人相关的信息。只有通过这种遗传信息的个人意义，信息导向的过程似乎才会导致不准确的感知。建议遗传咨询师将沟通重点放在这些个人过程上。
