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Barriers and stimuli for genetic counseling among unaffected women at high risk for breast cancer.

6144 Background: Genetic counseling (GC) is available to provide risk assessment and education about hereditary cancer, explore the medical and psychosocial impact of these risks, and to facilitate genetic testing (GT) and its complex interpretation. While the motivations for undergoing GT have been well documented, little is known about patient motives to initially seek GC. Current uptake of GC services does not match the number of eligible patients. This study attempted to characterize the barriers and stimuli for cancer GC among unaffected women at high risk for breast cancer.


METHODS
IRB approval was obtained for this qualitative interview study. 54 unaffected patients who received a cancer genetics referral from a high-risk breast clinic were invited to participate. 18 subjects completed written questionnaires and 60-min telephone interviews, which were audiotaped and transcribed. A detailed coding system was developed and N*Vivo software was used in order to identify themes in the factors affecting intent to pursue GC.


RESULTS
We identified four themes in the factors affecting uptake of GC: 1)patient understanding of GC, 2)patient awareness of increased cancer risk, 3) family-tied life events (e.g. reproduction, caretaking, death), and 4) support for GC from physicians and family. The most common theme was patient understanding of GC. Subjects did not seem to differentiate between GC and GT, and they deferred GC until they were prepared to undergo GT.


CONCLUSION
We identified barriers and stimuli for GC that were similar to those previously described for GT. The misconception that GC automatically leads to GT, and the subsequent low uptake of GC referrals, may be influenced by the current practice of non-directive referrals. Providing more directive referrals for GC, without being directive about GT, may reduce barriers to GC. No significant financial relationships to disclose.