INTERVENTIONS TO SUPPORT INFORMED DECISION MAKING ABOUT GERMLINE GENETIC TESTING FOR PATHOGENIC BRCA 1/2 VARIANTS: A SCOPING REVIEW

• Published in: Oncology nursing forum Vol. 50; no. 2; pp. A36 - A37
• Main Authors: Pozzar, Rachel, Seven, Memnun
• Format: Journal Article
• Language: English
• Published: Pittsburgh Oncology Nursing Society 01-03-2023
• Subjects: Decision making; Genetic counseling; Genetic testing; Oncology
• ISSN: 0190-535X; 1538-0688

Pathogenic BRCA1/2 variants are highly actionable and may inform hereditary breast and ovarian cancer (HBOC) treatment and prevention. However, rates of germline genetic testing (GT) in people with and without HBOC are suboptimal. Individuals' knowledge, attitudes, and beliefs may influence GT decisions. While genetic counseling (GC) promotes informed decision making, the supply of genetic counselors is insufficient to meet demand. Accordingly, there is a need to develop and test novel interventions to support informed BRCA1/2 testing decisions. The purpose was to characterize the existing literature on novel interventions to promote informed BRCA1/2 testing decisions in people with and without HBOC. We identified articles in PubMed, CINAHL, Web of Science, and PsycINFO using search terms related to HBOC, GT, and decision making. First, we screened titles and abstracts to identify peer-reviewed articles that described interventions to facilitate informed BRCA1/2 testing decisions. Next, we reviewed full texts and excluded studies that lacked statistical comparisons or enrolled previously tested individuals. Finally, we extracted study characteristics and findings into a table. Two authors performed each step independently; decisions were tracked in Rayyan and discrepancies were resolved through discussion. Of 2,089 unique citations, 25 met eligibility criteria. Articles were published between 1997-2021 and described randomized trials (23/25, 92%) and non-randomized, quasi-experimental studies (2/25, 8%). Most studies tested GC models (8/25, 32%) and educational interventions (10/25, 40%), nearly half (11/25, 44%) of which were designed to complement traditional GC. Intervention formats included one or more of the following: written materials (9/25, 36%); interactive software and decision aids (6/25, 24%); and telephone (6/25, 24%), individual (4/25, 16%), or group GC (3/25, 12%). Of the interventions compared to GC, 6/9 (67%) increased or had a noninferior effect on knowledge, 5/6 (83%) decreased or had a noninferior effect on decisional conflict, and 4/7 (57%) decreased GT uptake. Novel interventions may promote informed decision making, but many were developed to complement traditional GC. Further trials comparing novel interventions to GC are warranted. Our ability to compare findings across studies was limited by differences in outcome measures and changes in BRCA1/2 testing guidelines over time. Nevertheless, our findings highlight promising strategies for promoting informed decision making in people considering BRCA1/2 testing.