Albada Akke, Vernooij Madelèn, van Osch Liesbeth, Pijpe Anouk, van Dulmen Sandra, Ausems Margreet G E M
Department of Medical Genetics, University Medical Centre Utrecht, Utrecht, The Netherlands,
Fam Cancer. 2014 Mar;13(1):35-44. doi: 10.1007/s10689-013-9672-5.
To optimally inform counselees about their and their relatives' risks, information about lifestyle risk factors, e.g. physical activity and alcohol consumption, might be discussed in breast cancer genetic counselling. This study explored whether lifestyle was discussed, on whose initiative, whether information and/or advice was given, and whether discussion of lifestyle was related to counselees' characteristics and their causal attributions. First and follow-up consultations with 192 consecutive counselees for breast cancer genetic counselling were videotaped and coded for discussion of lifestyle topics. Counselees completed web-based questionnaires before the initial and after the final consultation. With 52 (27%) counselees lifestyle was discussed, either in the first, or the final consultation, or both. Counselees mostly raised the topic (60%). Counsellors provided information about lifestyle risk factors to 19% and lifestyle advice to 6% of the counselees. Discussion of lifestyle was not associated with counselees' characteristics or causal attributions. Post-counselling, more affected counselees considered lifestyle as a cause of their breast cancer (29%) compared to pre-counselling (15%; p = 0.003). Information and advice about lifestyle risk factors was infrequently provided, both with breast cancer unaffected and affected counselees and with those who did and did not consider their lifestyle as a cause of their breast cancer. Modifiable lifestyle factors could be discussed more frequently to optimally inform counselees about possible ways to reduce their risk. Counsellors should be educated about effects of lifestyle and research should be conducted on how to best integrate lifestyle information in breast cancer genetic counselling.
为了让咨询对象全面了解自身及其亲属的风险，在乳腺癌遗传咨询中可能会讨论生活方式风险因素，例如体育活动和饮酒情况。本研究探讨了生活方式是否被提及、由谁发起、是否给出了信息和/或建议，以及生活方式的讨论是否与咨询对象的特征及其因果归因有关。对192名连续接受乳腺癌遗传咨询的咨询对象的首次和后续咨询进行了录像，并对生活方式相关话题的讨论进行了编码。咨询对象在初次咨询前和最后咨询后完成了网络问卷。在52名（27%）咨询对象中，生活方式在首次咨询、最后咨询或两者中均被讨论。咨询对象大多主动提出该话题（60%）。咨询师向19%的咨询对象提供了生活方式风险因素的信息，向6%的咨询对象提供了生活方式建议。生活方式的讨论与咨询对象的特征或因果归因无关。咨询后，与咨询前（15%；p = 0.003）相比，更多受影响的咨询对象认为生活方式是其患乳腺癌的一个原因（29%）。无论是未受乳腺癌影响的咨询对象还是受影响的咨询对象，以及那些认为或不认为自己的生活方式是患癌原因的咨询对象，关于生活方式风险因素的信息和建议都很少提供。可以更频繁地讨论可改变的生活方式因素，以便让咨询对象全面了解降低风险的可能方法。应让咨询师了解生活方式的影响，并应开展研究，探讨如何在乳腺癌遗传咨询中最佳地整合生活方式信息。
