Context As the availability of and demand for genetic testing for hereditary
cancers increases in primary care and other clinical settings, alternative
or adjunct educational methods to traditional genetic counseling will be needed.
Objective To compare the effectiveness of a computer-based decision aid with standard
genetic counseling for educating women about BRCA1 and BRCA2 genetic testing.
Design Randomized controlled trial conducted from May 2000 to September 2002.
Setting and Participants Outpatient clinics offering cancer genetic counseling at 6 US medical
centers enrolled 211 women with personal or family histories of breast cancer.
Interventions Standard one-on-one genetic counseling (n = 105) or education by a computer
program followed by genetic counseling (n = 106).
Main Outcome Measures Participants' knowledge, risk perception, intention to undergo genetic
testing, decisional conflict, satisfaction with decision, anxiety, and satisfaction
with the intervention. Counselor group measures were administered at baseline
and after counseling. Computer group measures were administered at baseline,
after computer use, and after counseling. Testing decisions were assessed
at 1 and 6 months. Outcomes were analyzed by high vs low risk of carrying
a BRCA1 or BRCA2 mutation.
Results Both groups had comparable demographics, prior computer experience,
medical literacy, and baseline knowledge of breast cancer and genetic testing,
and both counseling and computer use were rated highly. Knowledge scores increased
in both groups (P<.001) regardless of risk status,
and change in knowledge was greater in the computer group compared with the
counselor group (P = .03) among women at low risk
of carrying a mutation. Perception of absolute risk of breast cancer decreased
significantly after either intervention among all participants. Intention
to undergo testing decreased significantly after either intervention among
low-risk but not high-risk women. The counselor group had lower mean scores
on a decisional conflict scale (P = .04) and, in
low-risk women, higher mean scores on a satisfaction-with-decision scale (P = .001). Mean state anxiety scores were reduced by counseling
but were within normal ranges for both groups at baseline and after either
intervention, regardless of risk status.
Conclusions An interactive computer program was more effective than standard genetic
counseling for increasing knowledge of breast cancer and genetic testing among
women at low risk of carrying a BRCA1 or BRCA2 mutation. However, genetic counseling was more effective than
the computer at reducing women's anxiety and facilitating more accurate risk
perceptions. These results suggest that this computer program has the potential
to stand alone as an educational intervention for low-risk women but should
be used as a supplement to genetic counseling for those at high risk.