Advances in Nursing / 2014 / Article / Tab 1

Review Article

Effectiveness of the Interventions Utilized in Genetic Counseling

Table 1

Summary of review.

Year, author, topicStudy aimsSubjects ( )Main interventionTimeframe of the evaluation Findings

2012,
Rothwell et al.,
(i) breast ca.,
(ii) ovarian ca.
[19].
To assess cognitive and affective outcomes with group and individual cancer genetic counseling participants on knowledge, perceived personal control, cancer specific, and genera distress Provide group genetic counseling session(i) A base line questionnaire,
(ii) after session questionnaire immediately after group genetic counseling
(i) Significant improvements of perceived personal control, general psychological distress and cancer-specific psychological distress scores in both individual and group genetic counseling groups,
(ii) high satisfaction scores in both individual and group genetic counseling groups

2012,
*Albada et al.,
breast ca.
[20].
To evaluate the effects of a previsit computer-tailored information and a question prompt sheet website Provide the previsit website called E-info geneca, which is a computer-tailored information and has a question prompt sheet that helps counselees’ formulate questions to ask the counselor(i) A base line questionnaire,
(ii) counselees’ genetic counseling sessions were videotaped
(i) Counselees in the intervention group did not ask more questions than those in usual care group,
(ii) counselors’ provide more information that is more counselees’ specific

2012,
*Albada et al.,
breast ca.
[21].
To evaluate the effects of a previsit computer-tailored information website on counselees’ expectations, knowledge of breast ca., and heredity and information needs Usual care (UC) plus providing the previsit website called E-info geneca: a computer-tailored information website, which provides genetic counseling procedure, hereditary breast ca., surveillance, DNA-testing, the meaning of carrier of cancer gene, and emotional consequences of genetic counseling (i) A base line questionnaire,
(ii) a questionnaire after having viewed the website
(i) Better know what to expect of their first visit in UC plus previsit website group than UC group,
(ii) less show unrealistic expectation visit in UC plus previsit website group than UC group,
(iii) increased knowledge of breast ca. and heredity in UC plus pre-visit website group than UC group,
(iv) lower information needs in UC plus previsit website group than UC group

2010,
Graves et al.,
breast ca.
[22].
To evaluate impact of a psychosocial telephone counseling Standard genetic counseling (SGC) plus psychosocial telephone counseling (PTC)(i) Before counseling interview,
(ii) 6-month after counseling interview,
(iii) 12-month after counseling interview
(i) PTC reduced depressive symptoms at 6 month compared to SGC,
(ii) less clinically significant anxiety found in women in SGC plus PTC group at 6 month,
(iii) no differences in anxiety and depression at 12 month

2010,
Pal et al.,
(i) breast ca.,
(ii) ovarian ca.
[23].
To evaluate the impact of telephone-based genetic counseling with culturally targeted visual aid and to evaluate factors associated with gains in knowledge Telephone-based genetic counseling (Phone GC) with culturally targeted visual aid (i) before counseling questionnaires,
(ii) after counseling questionnaires
(i) Phone GC improved knowledge about inherited breast and ovarian ca. in African Americana at high risk for inherited breast ca.,
(ii) participants with greater education showed significantly greater gain in knowledge,
(iii) women who had prior genetic counseling outside of this study showed significantly higher knowledge

2010,
Halbert et al.,
breast ca.
[24].
To evaluate the effects of culturally tailored genetic counseling (CTGC) over standard genetic counseling (SGC) Culturally tailored genetic counseling(i) Baseline interview before counseling
(ii) 1-month follow-up interview after counseling
(i) No differences in changes in risk perception in women both in CTGC and SGC groups,
(ii) improved risk perception found in women both in CTGC and SGC groups,
(iii) no changes in cancer worry in women both in CTGC and SGC groups.

2010,
Roussi et al.,
(i) breast ca.,
(ii) ovarian ca.
[25].
To evaluate an enhanced counseling intervention which is designed to help women anticipate and take inventory of their potential thoughts and feelings about possible outcomes after testing Enhanced counseling “cognitive-affective processing” procedure for women(i) Before counseling assessment performed in a session 1 week after self-initiated telephone contact,
(ii) after counseling assessment 1 week after intervention,
(iii) follow-up counseling 1 week after test results informed.
(i) Improved knowledge about hereditary of breast and ovarian cancer found in women who received enhanced counseling,
(ii) low anxiety found in women who tested positive and received enhanced counseling,
(iii) no significant effect of knowledge and anxiety found 1 week after test results disclosed in women in both groups

2011,
Castellani et al.,
cystic fibrosis
[26].
To assess the effectiveness of using an interactive computer program on education of cystic fibrosis. Education by the interactive computer programBaseline questionnaire at
(i) before counseling,
(ii) directly after counseling
program evaluation questionnaire after the counseling session
(i) No participants changed their intention to undergo testing after education by genetic counselor or interactive computer program,
(ii) overall improved knowledge found both in classical genetic counseling and in education by the interactive computer program

2009,
Roshanai et al.,
(i) breast ca.,
(ii) ovarian ca.,
(iii) colorectal ca.
[27].
To assess the effects of extended cancer genetic information on
(i) overall knowledge,
(ii) risk perception,
(iii) information sharing with family,
(iv) satisfaction with the counseling service
(i) Learning the breaking bad news methods,
(ii) written information materials on genetic risks,
(iii) video tape of the session
Face-to-face interview at
(i) before counseling,
(ii) directly after counseling,
(iii) 2 weeks after counseling;
phone interview at
(iv) 8 months after counseling
(i) Overall no major intervention effect,
(ii) accuracy of the personal risk estimation remained improved regardless of the intervention till 2 weeks after counseling,
(iii) overall high rate of informing relatives on the risk,
(iv) higher satisfaction on how to inform relatives among intervention group

2009,
Schwartz et al.,
(i) breast ca.,
(ii) ovarian ca.
[28].
To assess the effects of the CD-ROM-based decision aid on
(i) decision conflict,
(ii) decision satisfaction,
(iii) actual uptake of risk reducing mastectomy (RRM)
Interactive CD-ROM that shows tailored information mailed to the subjects after the counseling (i.e., usual care)Face-to-face interview at
(i) 1 month after counseling,
(ii) 6 months after counseling,
(iii) 12 months after counseling
(i) For those who undecided at randomization, the decision aid helped reach decision, reduce decision conflict, increase satisfaction with decision,
(ii) no effect on obtaining RRM,
(iii) decision aid effects persisted for the entire follow-up period

2009,
Bodurtha et al.,
breast ca.
[29].
To test the effects of providing information sheets on breast cancer health on
(i) intention to take breast cancer screening (mammography, breast self-exam, clinical breast exam),
(ii) actual uptake of breast cancer screening
Information sheets covering
(i) barriers to mammography,
(ii) breast cancer seriousness,
(iii) individual risk for breast cancer,
(iv) benefits of a yearly mammogram,
(v) recommendations for nutrition and physical activity
(i) Baseline survey by self-administered paper questionnaire,
(ii) follow-up survey by phone interview
No intervention effect on intention and actual uptake of
(i) overall mammography,
(ii) breast self-exam,
(iii) clinical breast exam
between the intervention and control groups,
(iv) women who reported breast ca. worry often
or all the time at baseline had higher rates of mammograms in the intervention group compared with controls at follow-up.

2008,
Wakefield et al.,
colorectal ca.
[30].
To assess the effects of paper-based decision aid on
(i) decision conflict,
(ii) knowledge,
(iii) informed choice,
(iv) family involvement,
(v) psychological distress,
(vi) decision regret,
(vii) decision to take genetic test
(i) 40 pages long decision aids that explain details on the colorectal cancer, genetic testing, and benefits and risks of genetic testing,
(ii) provided at the end of the first counseling session
Questionnaire survey at
(i) 1 week after counseling,
(ii) 6 months after counseling
Significant intervention effects of
(i) decreased decisional conflict,
(ii) increased knowledge,
(iii) better informed choice,
(iv) the effects observed in both follow-ups;
no effect on
(i) family involvement,
(ii) psychological distress,
(iii) decision regret,
(iv) intention to take genetic test

2008,
Wakefield et al.,
breast/ovarian ca.
[31].
To assess the effects of paper-based decision aid on
(i) decision conflict,
(ii) knowledge,
(iii) informed choice,
(iv) family involvement,
(v) psychological distress,
(vi) decision regret,
(vii) decision to take genetic test
(i) 40 pages long decision aid that explains the details on the breast/ovarian cancer, genetic testing, and benefits and risks of genetic testing,
(ii) provided in the beginning of the first counseling session
Questionnaire survey at
(i) 1 week after counseling,
(ii) 6 months after counseling
Intervention effects of
(i) higher feeling of well informed,
(ii) higher clarity of values,
(iii) higher knowledge level,
(iv) lower psychological distress level,
(v) lower decision regret at 6 months;
no effect on
(i) decisional conflict,
(ii) informed choice,
(iii) family involvement,
(iv) genetic testing uptake

2008,
Kelly et al.,
ovarian ca.
[32].
To test the effects of genetic counseling on subjective risk of
(i) ovarian cancer over time,
(ii) discrepancy between subjective and objective ovarian cancer risk
Genetic counseling that incorporates Leventhal’s common sense model-based conceptualization of subjective ovarian cancer riskInterview at
(i) baseline,
(ii) immediately after counseling;
questionnaire survey at
(iii) 6 months after counseling
(i) Most inaccurate subjective risk in patients with breast cancer history before counseling but accuracy improved after counseling,
(ii) improved subjective perception of survival time with ovarian cancer
after counseling,
(iii) consistent underestimation in patients with positive testing results at before and after counseling,
(iv) changes of underestimation to overestimation in patients with uninformative negative results at before and after counseling

2007,
Glanz et al.,
colorectal ca.
[33].
To assess the effects of culturally sensitive tailored colorectal cancer risk counseling with follow-ups on adherence to screening guideline (i) Individual face-to-face health counseling,
(ii) tailored print materials,
(iii) 2 follow-up calls with reinforcement, reeducation, and positive reinforcement
Face-to-face interview at
 baseline;
phone interviews at
(i) 4 months after counseling,
(ii) 12 months after counseling
Intervention effects of
(i) higher screening adherence at 4 months,
(ii) continuous increase in adherence till 12 months,
(iii) larger effects among people noncompliant at baseline

2007,
Ozanne et al.,
breast ca.
[34].
To test the effects of the decision aid on
(i) decision-making knowledge on breast cancer prevention,
(ii) satisfaction
An interactive, computer-based decision aid that covers
(i) breast ca. risk assessment,
(ii) breast ca. risk in perspective,
(iii) prevention options,
(iv) options to learn about breast ca. risk
Questionnaire survey at
(i) before counseling,
(ii) after counseling,
(iii) 6–11 months after counseling
(i) Significant intervention effects of
improved knowledge,
(ii) no significant effects of
improved satisfaction

2006,
Lobb et al.,
breast ca.
[35].
To test the effect of the illustrated and structured breast cancer risk communication aid on
(i) knowledge on breast cancer,
(ii) perceived risk,
(iii) anxiety,
(iv) counseling satisfaction,
(v) communication satisfaction
A communication aid with
(i) illustrated risk level,
(ii) risk definition,
(iii) brief lessons on cancer genetics,
(iv) risk factors,
(v) factors determining genetic testing,
(vi) things to do to minimize risk
Questionnaire survey at
(i) baseline,
(ii) 1 week after counseling
No intervention effect on
(i) knowledge (except male inheritance),
(ii) risk perception,
(iii) anxiety,
(iv) satisfaction

2006,
Bowen et al.,
breast ca.
[36].
To examine the effects of genetic counseling or psychosocial group counseling on
(i) cancer worry,
(ii) risk perception,
(iii) interests in having genetic testing
4 sessions of 2 hrs long psychosocial group counseling (5-6 people) led by general health counselor;
topics on
(i) risk assessment,
(ii) risk perception,
(iii) education on genetic risk,
(iv) stress management,
(v) problem solving,
(vi) social support;
one time 1 hr long individual genetic counseling led by genetic counselor;
topics on
(i) family background,
(ii) breast ca. risk assessment, BRCA mutation in Ashkenazi population,
(iii) nongenetic risk factors for breast cancer,
(iv) breast screening
Questionnaire survey at
(i) baseline,
(ii) 6 months after counseling
Intervention effects of
(i) reduced worry about cancer,
(ii) lowered inflated risk perception,
(iii) decreased interest in having genetic testing
(iv) increased awareness on need of privacy related to genetic testing
No difference between the two types of counseling

2006,
Charles et al.
breast ca.
[37].
To examine the effects of culturally tailored genetic counseling on
(i) satisfaction,
(ii) cancer worries
Culturally tailored genetic counseling that covers
(i) basic education on hereditary breast and ovarian cancer,
(ii) genetic testing on BRCA mutation,
(iii) cancer risk information
(iv) discussion about cultural beliefs and values
(i) Structured phone interview at baseline,
(ii) questionnaire survey immediately after counseling
Intervention effects of
(i) increased satisfaction with counseling,
(ii) decreased cancer worries

2006,
Matloff et al.,
breast ca.
[38].
To examine the effects of personalized genetic counseling including risk assessment of breast cancer on
(i) attitude toward menopausal therapy options
(ii) knowledge on cancer risk
(iii) perception of cancer risk
Two individualized counseling including personalized future risk of
(i) breast/endometrial cancer,
(ii) heart disease,
(iii) osteoporosis
Questionnaire survey at
(i) baseline,
(ii) 1 month after counseling,
(iii) 6 months after counseling
Intervention effects of
(i) higher knowledge level on menopausal treatment at both follow-up time points,
(ii) significantly improved accuracy in perceived risk level for breast cancer at both follow-up time points than at baseline (but persisted overestimation),
(iii) higher perceived effectiveness in decision making at 6 months follow-up;
no effect on
(i) decisional conflict at both follow-up time points,
(ii) accepting menopausal therapy,
(iii) accepting chemoprevention of breast cancer

2006,
Arimori,
prenatal testing
[39].
To explore the effect of the Ottawa personal decision guide on decision conflict Explaining and guiding the women through the five steps of Ottawa personal decision guide during the prenatal counselingSelf-reporting questionnaire at
(i) immediately after the genetic counseling,
(ii) after the subject had made their decision about prenatal testing
Significant intervention effect of
lower level of decisional conflict in the intervention group

2005,
Miller et al.,
breast ca.
[40].
To examine the effects of education on
(i) knowledge on hereditary cancer,
(ii) knowledge on personal family history of cancer,
(iii) perceived risk,
(iv) knowledge on genetic testing,
(v) intention to get genetic testing
Enhanced information provision during the phone-based cancer information service;
topics on
(i) the kinds of information required to determine inherited risk,
(ii) counselee’s personal family history of cancer,
(iii) benefits and limitations of genetic testing
Phone interview at
(i) baseline,
(ii) 2 weeks after counseling,
(iii) 6 months after counseling,
(iv) 12 months after counseling
Intervention effects of
(i) reduced intention to obtain genetic testing among women at average risk,
(ii) increased intention among high-risk women at 6 months,
(iii) greater increases in knowledge and perceived risk over the 6 months among high monitors;
no significant effects on
(i) knowledge about breast cancer,
(ii) knowledge about inherit patterns of cancer risk,
(iii) process of risk assessment

2005,
Miller et al.,
breast ca.
[41].
To examine the effects of the enhanced counseling on
(i) avoidant ideation after receipt of the genetic test result,
(ii) seeking information about their risk reduction options,
(iii) taking preventive surgery
45 min long enhanced counseling added to the standard counseling that covers
(i) 3 scenarios of genetic testing results (i.e., positive, negative, uninformative),
(ii) preliving the feeling and thoughts of each scenario,
(iii) discussion on the meaning of each scenario of result,
(iv) risk reduction options for each scenario result,
(v) discussion on the impact of each result on life
Questionnaire survey at
(i) baseline,
(ii) 1 week after counseling,
(iii) 6 months after counseling
Intervention effects of
(i) less avoidant ideation at 1 week after counseling,
(ii) more uptake of preventive surgery among women with positive results at 6 months after counseling,
(iii) more information seeking on risk reduction (college educated women less opt in for preventive surgery) at 6 months after counseling

2005,
Griffith et al.,
prenatal genetic screening
[42].
To test the effects of interactive computer assisted instruction program on
(i) knowledge,
(ii) anxiety,
(iii) satisfaction,
(iv) time spent on prenatal care visit,
(v) reactions of providers
Precounseling interactive computer assisted instruction (ICAI) that covers topics on
(i) types of birth defect/disease,
(ii) risk of birth defect/disease,
(iii) testing on the birth defect/disease,
(iv) accuracy of the testing,
(v) making testing decision
Questionnaire survey at
(i) baseline,
(ii) post-ICAI,
(iii) postcounseling
Significant intervention effects of
(i) improved knowledge
(ii) high satisfaction
No intervention effect on
(i) anxiety
(ii) time spent on education
Providers response of
(i) helpful printout
(ii) right amount of information
(iii) less or same amount of education time
(iv) disruption of flow (9 out of 16)

2005,
Brain et al.,
colorectal ca.
[43].
To explore the process of extended versus shortened genetic counseling protocols and to compare their impact on
(i) psychological outcomes,
(ii) decision-making outcomes in individuals eligible for genetic testing
(i) Extended counseling (2 sessions 4 weeks apart) with educational and reflective components,
(ii) shortened counseling (1 session) with only core educational components
Questionnaire survey at
(i) baseline,
(ii) immediately after counseling and 3 months after counseling;
semistructured interviews at various time points (on average 16 months) of postcounseling
No differences in 2 methods on
(i) preferred informational counseling easiness of making decisions to take test,
(ii) no differences in psychological distress immediately after the counseling,
(iii) small improvement in knowledge in both groups,
(iv) overall highly satisfied with counseling;
positive effects of shortened counseling of
(i) less distress at 3 months after counseling,
(ii) more satisfaction with decision

2005,
Braithwaite et al.,
breast ca.
[44].
To test the impact of using a computerized genetic risk assessment tool GRACE (genetic risk assessment in clinical environment) in
(i) risk perception,
(ii) emotional reactions
Pedigree assessment using GRACE and presentation of the risk in 3 formats of
(i) numerical estimate of lifetime breast cancer risk,
(ii) visual display of cumulative breast cancer risk with a general population risk as a comparator,
(iii) qualitative descriptions
Questionnaire survey at
(i) baseline,
(ii) immediatly after counseling,
(iii) 3 months after counseling
(i) Use of GRACE improved accuracy in perceived risk in both postcounseling evaluations,
(ii) patients preferred nurse counseling than GRACE,
(iii) no intervention effect on cancer related worries,
(iv) preferred numeric form and text narration, least preferred graphic form

2005,
Green et al.,
breast ca.
[45].
To test the effectiveness of precounseling computer-based education on patient’s and counselor’s perspective on
(i) efficiency,
(ii) duration of counseling, content compared to standard counseling
Self-paced, user-driven CD-ROM-based precounseling education designed to educate women about
(i) breast cancer in general,
(ii) heredity of breast cancer,
(iii) benefits and limitations of genetic testing
Questionnaire survey at
(i) baseline,
(ii) immediately after computer education,
(iii) immediately after counseling
Intervention effects of
(i) increased effectiveness by counselors and patients,
(ii) patients perceived greater level of effectiveness than counselors,
(iii) counselors indicated that the intervention group showed better understanding of heredity of breast cancer,
(iv) shorter duration of counseling, especially, among low risk patients,
(v) content shift to specific concerns of individual than basic concept education,

2005,
Wang et al.,
breast ca.
[46].
To test the usefulness of
(i) precounseling education,
(ii) personalized/tailored genetic counseling
synergistic effects of both
on
(i) counseling duration,
(ii) worry about gene mutation,
(iii) knowledge,
(iv) genetic testing decision
(i) 15 minutes long CD-ROM-based precounseling education,
(ii) preliminary knowledge testing with feedback to counselor (areas that need more education)
(i) Baseline for worry about gene mutation,
(ii) immediately after CD-ROM education for knowledge,
(iii) during the counseling for counseling duration,
(iv) immediately after counseling for worry about gene mutation and knowledge,
(v) chart review for genetic testing uptake
(i) CD-ROM group spent less with genetic counselor,
(ii) feedback group spent more with medical oncologist,
(iii) no significant combined effect,
(iv) more improved knowledge in feedback group at immediate postcounseling,
(v) greater decrease among CD-ROM group, especially among those with low level of worries at baseline,
(vi) increased worry after counseling among control group with low level of worries at baseline,
(vii) CD-ROM group significantly less opt for genetic testing,
(viii) no feedback/combined effect on genetic testing uptake

2005,
McInerney-Leo et al.,
breast/ovarian ca.
[47].
To test the effects of problem solving training (PST) in psychological distress around genetic testing and its results PST consists of
(i) description of different types of coping and problem solving strategies (i.e., task-focused and emotion-focused),
(ii) use of checklist to identify problem or challenge faced by the patient,
(iii) generation of solutions,
(iv) solution evaluation,
(v) identification of barriers,
(vi) decision making strategy,
(vii) solution implementation plan
(i) Questionnaire survey at baseline,
(ii) phone interview at 6–9 months after genetic testing results became available
(i) Greater reductions in depressive symptom among PST group regardless of the test,
(ii) biggest improvement in psychological well-being among those resulted as negative,
(iii) no significant change in psychological well-being among those resulted as positive or nontest takers,
(iv) testers had greater improvements than nontesters in breast cancer worries,
(v) people with cancer history had significantly greater increase in breast cancer worries

2004,
Green et al.,
breast ca.
[48].
To test the effects of interactive computer program on
(i) knowledge, risk,
(ii) perception,
(iii) decisions on genetic testing,
(iv) postintervention decisional conflict,
(v) satisfaction with the educational methods
CD-ROM-based interactive precounseling educational program that covers
(i) breast cancer in general,
(ii) heredity of breast cancer,
(iii) benefits and limitations of genetic testing
Questionnaire survey at
(i) baseline assess
(ii) immediately after precounseling education,
(iii) immediately after counseling,
(iv) 1 month after counseling,
(v) 6 months after counseling,
(i) Increased knowledge in both groups but significantly higher in intervention group, in low risk group and in low education group,
(ii) significantly lowered perceived risk among low risk control group did not lowered much among high risk group,
(iii) slightly lowered perceived risk among low risk intervention group—further lowered after counseling,
(iv) lowered intention to among low risk group, less reduction among intervention group—further reduced after counseling,
(v) lowered decision conflict in both groups,
(vi) anxiety reduced in counseling group, less reduction in computer group, further reduced after counseling,
(vii) slightly higher satisfaction among low risk counselor group,
(viii) no difference in satisfaction among high risk group,
(ix) better scored in “providing enough information for decision making” among high risk counseling group,
(x) better score in “reassurance” among low risk counseling group,
(xi) better score on “good use of time” among computer group

2004,
Emmons et al.,
colorectal ca.
[49].
To test the effect of computerized risk assessment tool on colorectal risk on the accuracy of colorectal cancer risk perception (i) Use of the Harvard colorectal cancer risk assessment and communication tool for research (HCCRACT-R) in assessing colorectal cancer risk,
(ii) HCCRACT-R supports readjustment of risk level by patients healthy behavior (i.e., active engagement) and representation of risk level in various formats (qualitative relative risk, frequency-1 in -format of absolute risk
Interviews at
(i) before counseling
(ii) after counseling
Significant intervention effects of
(i) improved accuracy in risk perception,
(ii) higher improvement in active engagement than passive engagement group;
no intervention effect on
(i) cancer worries,
(ii) satisfaction

2004,
van Roosmalen et al.,
breast ca.
[50].
To test the impact of a decision aid and its timing on
(i) well-being (depression, anxiety, cancer distress),
(ii) making treatment decision,
(iii) evaluation of treatment,
(iv) decision outcome (preference, uncertainty),
(v) knowledge level,
(vi) subjective knowledge,
(vii) satisfaction with the information,
(viii) risk perception
Brochure and video on
(i) breast cancer screening,
(ii) prophylactic surgery;
decision aids provided
(i) before test results,
(ii) after test results (to those who did not receive DA but resulted positive)
Questionnaire survey at
(i) baseline,
(ii) 4 weeks after blood sampling (before test results),
(iii) 2 weeks after test results
No significant effect of decision aid on
(i) psychological well-being,
(ii) decision outcomes;
positive effects of decision aid on
(i) selecting preventive surgery and its valuation,
(ii) information related outcome,
(iii) satisfaction,
(iv) accurate risk level perception;
no effect of timing of decision aid on any outcome variables

2002,
Brain et al.,
breast ca.
[51].
To examine the impact of specialist genetic services on
(i) anxiety,
(ii) worry,
(iii) perceived risk,
(iv) interest in genetic testing,
(v) satisfaction
Multidisciplinary team care that includes specialist genetic risk assessment and counselingQuestionnaire survey at
(i) baseline,
(ii) immediately after counseling,
(iii) next follow-up visit
(i) No intervention effect on anxiety but decreased at follow-up visit,
(ii) no intervention effect on cancer worry but significant reduction at follow-up among low, moderate risk group,
(iii) significant improvement in perceived risk in low, moderate risk group on follow-up visit. The effect was larger among intervention group
(iv) No intervention effect on satisfaction: high risk group less satisfied than mod or low risk group
(v) No intervention effect on interest in genetic testing: decreased in all groups regardless of intervention

2002,
Bowen et al.,
breast ca.
[52].
To test the effects of breast cancer risk counseling on interest in pursuing genetic testing Individual genetic counseling with
(i) precounseling pedigree assessment,
(ii) personal risk level,
(iii) relative risk level,
(iv) heredity of breast cancer,
(v) information about genetic testing;
group psychosocial counseling with 4–6 people on
(i) risk assessment,
(ii) risk perception,
(iii) education,
(iv) stress management,
(v) problem solving,
(vi) social support
Questionnaire survey at
(i) baseline,
(ii) 6 months after counseling
(i) Increased correct awareness of genetic testing candidacy in both counseling groups,
(ii) decreased interest in taking genetic testing in both counseling groups and control group,
(iii) increased awareness on the stigma and risk related to genetic testing in both counseling group

2001,
Hurt et al.,
breast ca.
[53].
To test the effects of accompanying psychological distress management training with risk assessment on level of distress related to breast cancer risk Psychological distress management training accompanied with risk assessmentQuestionnaire by telephone interview at
(i) baseline measure before intervention,
(ii) 1 month after intervention
Intervention effect of
(i) decreased distress,
(ii) increased knowledge,
(iii) increased satisfaction with intervention

2001,
Schwartz et al.,
breast ca.
[54].
To test the effects of genetic testing education booklet on
(i) knowledge about genetic testing,
(ii) perceived importance of the benefits and the limitations of the testing,
(iii) intention to take genetic testing
Genetic testing education (GTE) booklets with question-and-answer format and with both text and graphic presentation of informationProfessional telephone interview using a computer-assisted telephone interviewing
(i) before intervention,
(ii) 1 month after intervention
Significant intervention effects of
(i) GTE (genetic testing education) improved knowledge,
(ii) improved understanding on the benefits and the limitations of genetic testing,
(iii) moderate effects on testing intentions

2001,
Green et al.,
breast ca.
[55].
To test the effects of an interactive computer education program and a certified genetic counselor led education/counseling program on
(i) knowledge about breast cancer risk and genetic testing,
(ii) intention to undergo genetic testing
An interactive computer program that provides information about
(i) breast cancer, risk,
(ii) genetic testing;
education and individualized counseling by a certified genetic counselor
Questionnaires at
(i) baseline,
(ii) before intervention,
(iii) after intervention
Significant effects of both interventions of
(i) improved knowledge,
(ii) reduced intention to take genetic testing

2001,
Green et al.,
breast ca.
[56].
To test the effects of an interactive computer education program and a certified genetic counselor led education/counseling program on
(i) satisfaction,
(ii) preference
An interactive computer program that provides information about
(i) breast cancer, risk,
(ii) genetic testing;
education and individualized counseling by a certified genetic counselor
A self-administered questionnaire at
(i) baseline measure,
(ii) after measure only
Preferred the genetic counselor for
(i) the personal nature of interaction,
(ii) empathy,
(iii) provision of immediate answers to questions,
(iv) thoroughness,
(v) knowledge of the counselor,
(vi) provision of patient specific information.
Preferred computer program for
(i) user control,
(ii) ease of use,
(iii) efficient,
(iv) informative,
(v) aesthetics of the program,
(vi) privacy.

1999,
Drake et al.,pPrenatal testing
[57].
To test the effect of decision aids on
(i) knowledge about prenatal testing,
(ii) decisional conflict,
(iii) anxiety levels when considering prenatal testing,
(iv) anxiety trait level
Use of self-paced decision aid that consisted of a workbook, an audiotape, and a worksheet before prenatal counselingQuestionnaire survey
(i) before decision aid use,
(ii) after decision aid use
Significant intervention effects of
(i) higher knowledge,
(ii) decreased decision conflict,
(iii) women had statistically lower trait anxiety levels

An article was retracted. (http://breast-cancer-research.com/content/14/2/R37).