Brédart Anne, Kop Jean-Luc, De Pauw Antoine, Caron Olivier, Fajac Anne, Noguès Catherine, Stoppa-Lyonnet Dominique, Dolbeault Sylvie
Institut Curie, Supportive Care Department, Psycho-oncology Unit 26 rue d'Ulm, 75005 Paris Cedex 05, France; University Paris Descartes, 71, Avenue Edouard Vaillant, 92774 Boulogne-Billancourt, France.
Université de Lorraine, Inter-Psy, Inter-Psy, 3 Place Godefroy de Bouillon, BP 33 97, 54 015 Nancy Cedex, France.
Breast. 2017 Feb;31:121-127. doi: 10.1016/j.breast.2016.10.024. Epub 2016 Nov 9.
Information provision during BRCA1/2 genetic counseling is complex and expected to be increasingly so with gene panel testing. This prospective study evaluated whether genetic knowledge in counselees with breast cancer (BC) after a pre-test genetic counseling visit (T1) enhance their feeling of personal control while minimizing distress after the notification of BRCA1/2 result (T2). At T1, 243 (89% response rate) counselees completed questionnaires on genetic knowledge (BGKQ), perceived cancer genetic risk; of which, at T2, 180 (66%) completed the BGKQ again, scales of anxiety/depression, distress specific to genetic risk, and perceived control. Multilevel models were performed accounting for clinician, and testing an effect of knowledge on psychological outcomes according to the adequacy of counselees' perceived genetic predisposition to cancer. The mean knowledge score was moderate at T1, decreased while not significantly differing by BRCA1/2 test result at T2. Knowledge at T1 had no direct effect on psychological outcomes, but in counselees who over-estimated their cancer genetic risk, higher knowledge at T1 predicted higher specific distress at T2. In BC affected counselees who over-estimate their cancer genetic risk, higher BRCA1/2 pre-test genetic knowledge seem to lead to increased specific distress. Identifying these BC affected counselees who over-estimate their genetic cancer risk and helping them to interpret their genetic knowledge instead of providing them with exhaustive genetic information could minimize their distress after test result receipt.
在BRCA1/2基因咨询过程中提供信息很复杂，而且随着基因检测面板的使用，这种情况预计会越来越复杂。这项前瞻性研究评估了乳腺癌（BC）患者在进行检测前基因咨询就诊（T1）后所掌握的基因知识是否能增强他们的个人控制感，同时将BRCA1/2检测结果告知后的痛苦降至最低（T2）。在T1时，243名（89%的回复率）咨询对象完成了关于基因知识（BGKQ）、感知到的癌症遗传风险的问卷调查；其中，在T2时，180名（66%）再次完成了BGKQ、焦虑/抑郁量表、特定于遗传风险的痛苦量表以及感知控制量表。采用多水平模型，考虑临床医生因素，并根据咨询对象对癌症遗传易感性的感知充分程度，测试知识对心理结果的影响。T1时的平均知识得分中等，T2时有所下降，但BRCA1/2检测结果不同时差异不显著。T1时的知识对心理结果没有直接影响，但在高估其癌症遗传风险的咨询对象中，T1时知识水平越高，T2时的特定痛苦程度越高。在高估其癌症遗传风险的BC患者中，较高的BRCA1/2检测前基因知识似乎会导致特定痛苦增加。识别这些高估其遗传癌症风险的BC患者，并帮助他们解读其基因知识，而不是为他们提供详尽的基因信息，可以将他们收到检测结果后的痛苦降至最低。
