Psychological Impact of Genetic Counseling for Familial Cancer: A Systematic Review and Meta-analysis

Dejana Braithwaite, Jon Emery, Fiona Walter, Toby Prevost, Stephen SuttonPresentation by: Jennifer

Kyanko

PURPOSE To determine the quality and

strength of evidence related to psychological outcomes of genetic counseling for familial cancer due to the identification of a genetic basis of certain types of these cancers.

Genetic Counseling Definition: Individual counseling aimed at

supporting discussion about familial cancer risk and its management, including cancer surveillance and genetic testing.

Can be conducted before or after genetic testing.

Genetic counseling was implemented on patients at risk for breast, ovarian, and colorectal cancer.

Dependent Measures Anxiety Distress Depression Cancer Worry Risk Perception Knowledge

Literature Review Inception-December 2001 Methods

Databases included: MEDLINE, PsycINFO, Cancer-Lit, Cinahl, EMBASE, and the Web of Science Citation Index.

Used terms: breast neoplasms, ovarian neoplasms, colorecatal neoplasms, genetics medical, risk assessment, risk management, genetic counseling, and risk counseling.

43 studies, 18 extracted for not fitting definition lacking prospective data

ResultsDomain of Measurement

Time Point of Follow up

Standardized Differences (95% CI)

Anxiety Post clinic2 weeksShort term4-6 months9 monthsLong Term

0.11 (-0.05, 0.28)-0.01 (-0.54, 0.52)0.10 (-0.06,0.26)-0.28 (-.096, 0.39)0.10 (-0.07, 0.27)0.05 (-0.21, 0.31)

Distress 3 Months -0.08 (-0.34, 0.17)

Depression 2 weeks4-6 months

0.07 (-0.46, 0.60)-0.37 (-1.05, 0.31)

Results (continued)Domain of Measurement

Time Point of Follow up

Standardized Differences (95% CI)

Cancer Worry Post Clinic2 WeeksShort Term3 months 4-6 months9 monthsLong Term

0.02 (-0.15, 0.19)-0.26 (-0.79, 0.27)-0.01 (-0.17, 0.15)-0.30 (-0.56, -0.05)-0.21 (-0.89, 0.46)-0.03 (-0.19, 0.14)-0.14 (-0.35, 0.06)

Risk Perception Post Clinic1 monthShort Term 9 months

-0.15 (-0.32, 0.02)0.00 (-0.23, 0.23)-0.10 (-0.23, 0.04)-0.13 (-0.29, 0.04)

Results (continued)Domain of Measurement

Time Point of Follow up

Standardized Difference (95% CI)

Knowledge Post clinic2 weeks1 monthShort Term4-6 months

0.26*0.94* 0.96*0.70*0.80*

Potential Moderators General reaction regarding cancer is high

anxiety, distress, depression, worry. Most may seek accuracy of their perceived

risk and more knowledge about the type of cancer.

Mostly women Few studies conducted with accurate data Communication strategies

Conclusions Genetic counseling does not

significantly decrease anxiety, distress,depression, cancer worry, nor does it significantly increase risk perception.

Significantly increases knowledge about cancer, cancer prevention, and risk factors