Effectiveness of the Interventions Utilized in Genetic Counseling

Table 1

Summary of review.

Year, author, topic	Study aims	Subjects (𝑁)	Main intervention	Timeframe 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	𝑁=65	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	𝑁=197	Provide the previsit website called E-info gene^ca, 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	𝑁=190	Usual care (UC) plus providing the previsit website called E-info gene^ca: 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	𝑁=128	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	𝑁=37	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)	𝑁=176	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	𝑁=137	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.	𝑁=44	Education by the interactive computer program	Baseline 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	𝑁=147	(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)	𝑁=188	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	𝑁=899	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	𝑁=153	(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	𝑁=148	(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	𝑁=78	Genetic counseling that incorporates Leventhal’s common sense model-based conceptualization of subjective ovarian cancer risk	Interview 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	𝑁=164	(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	𝑁=30	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	𝑁=27	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	𝑁=221	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	𝑁=54	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	𝑁=43	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	𝑁=96	Explaining and guiding the women through the five steps of Ottawa personal decision guide during the prenatal counseling	Self-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	𝑁=279	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	𝑁=77	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	𝑁=207	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	𝑁=22	(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	𝑁=72	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	𝑁=211	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	𝑁=197	(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	𝑁=212	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	𝑁=211	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	𝑁=353	(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 𝑁-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	𝑁=368	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	𝑁=735	Multidisciplinary team care that includes specialist genetic risk assessment and counseling	Questionnaire 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	𝑁=357	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	𝑁=20	Psychological distress management training accompanied with risk assessment	Questionnaire 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	𝑁=391	Genetic testing education (GTE) booklets with question-and-answer format and with both text and graphic presentation of information	Professional 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	𝑁=29	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	𝑁=72	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	𝑁=21	Use of self-paced decision aid that consisted of a workbook, an audiotape, and a worksheet before prenatal counseling	Questionnaire 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).