Department of Clinical Genetics, Center for Human and Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands.
Psychooncology. 2013 Apr;22(4):902-10. doi: 10.1002/pon.3081. Epub 2012 Jun 27.
Several studies have shown that counselees do not experience psychopathological levels of distress after DNA test result disclosure. However, it has not systematically been studied whether the absence of psychopathology also means that counselees do not want to receive help. Their self-reported request for help may be related not only with psychopathology/distress but also with other psychological needs (e.g., surgery decisions), genetics-specific needs (e.g., feeling vulnerable/stigmatized), and existential concerns (e.g., meaning in life).
Questionnaires were filled in by Dutch cancer patients, before and after disclosure of BRCA1/2 test results for hereditary breast/ovarian cancer: pathogenic mutation results (n = 30), uninformative results (n = 202), or unclassified variants (n = 16). Newly developed questions measured request for help, psychopathology was estimated with factor analyses on distress/psychopathology instruments, and several validated questionnaires measured other needs/concerns.
One-third of all counselees who reported a request for psychological help had actually received help. The level of psychopathology correlated between 0.34 and 0.44 with this self-reported need-for-help. Other needs, genetics-specific distress, and existential concerns correlated strongly/moderately with the counselees' self-reported need-for-help. Examples of other needs were intention to undergo surgery, inaccuracy of their interpretation, the impact of cancer, and family communication difficulties. Genetics-specific distress was for instance feeling vulnerable to develop cancer, stigma, and lack of mastery. Existential concerns were, among others, lack of purpose in life, low self-acceptance, and an unfulfilled wish for certainty.
The request for help is related to multiple factors. Referral to psychosocial professionals may be improved by not only discussing psychopathology during genetic-counseling sessions but also by other needs and existential concerns. Questions about other needs and existential issues may be added to psychological screening instruments.
多项研究表明，咨询者在 DNA 检测结果披露后不会出现心理病理学水平的困扰。然而，尚未系统地研究这种无病理状态是否也意味着咨询者不想寻求帮助。他们自我报告的求助请求可能不仅与心理病理学/困扰有关，还与其他心理需求（例如手术决策）、基因特异性需求（例如感到脆弱/被污名化）和存在问题（例如生活意义）有关。
荷兰癌症患者在披露 BRCA1/2 遗传性乳腺癌/卵巢癌检测结果之前和之后填写问卷：致病性突变结果（n=30）、无信息结果（n=202）或未分类变体（n=16）。新开发的问题衡量了求助请求，使用困扰/心理病理学工具的因子分析来评估心理病理学，并且还使用了几个经过验证的问卷来衡量其他需求/关注点。
三分之一报告有心理求助需求的咨询者实际上已经获得了帮助。报告的求助需求与心理病理学之间的相关性在 0.34 到 0.44 之间。其他需求、基因特异性困扰和存在问题与咨询者的自我报告的求助需求密切相关。其他需求的例子包括手术意图、解释不准确、癌症的影响以及家庭沟通困难。基因特异性困扰例如易患癌症、污名化、缺乏掌控感。存在问题包括生活缺乏目标、自我接纳度低以及对确定性的未满足愿望。
求助请求与多个因素有关。在遗传咨询会议上不仅讨论心理病理学，还讨论其他需求和存在问题，可能会改善向心理专业人士的转介。可以在心理筛查工具中添加其他需求和存在问题的问题。
