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Randomized Comparison of Group Versus Individual Genetic Education and Counseling for Familial Breast and/or Ovarian Cancer

From the Genetics Branch, Center for Cancer Research; Orkand Corporation, Contractor; Center for Cancer Research, Biostatistics and Data Management Section; Center for Cancer Research, Laboratory of Cellular and Molecular Biology; National Cancer Institute, National Institutes of Health; National Center for Complementary and Alternative Medicine, National Institutes of Health; Uniformed Services University, Bethesda, MD; and Genentech, Inc, San Francisco, CA

Address reprint requests to Kathleen A. Calzone, RN, MSN, APNG, National Cancer Institute, Center for Cancer Research, Genetics Branch, 8901 Wisconsin Ave, Bldg 8, Rm 5101, Bethesda, MD 20889-5105; e-mail: calzonek{at}mail.nih.gov

PURPOSE: An efficient approach to education and counseling before BRCA1 and BRCA2 mutation testing is necessary for effective utilization of testing in the community. Education and counseling, when delivered individually, are limited by a shortage of trained health care providers as well as by financial and time constraints. The purpose of this study was to determine whether pretest education and counseling for breast cancer genetics in a group setting is equivalent to that provided on an individual basis.

PATIENTS AND METHODS: One hundred forty-two patients at high risk for harboring a BRCA mutation were randomly assigned to group or individual education and counseling sessions. Group education was followed by brief individual counseling. Knowledge and Impact of Events Scales (IES) were administered at baseline and after education and counseling and at 1 week and 3, 6, and 12 months. Satisfaction with education and counseling was measured at completion of the session. Preferred method of education and counseling was solicited at 3 months.

RESULTS: There was no difference in knowledge or IES scores between groups. When stratified by genetic test results, knowledge scores showed no difference. Regardless of group, post-test IES scores in patients with positive results were higher than patients with negative or uninformative results but returned to baseline by 12 months. Participants were equally satisfied with either method they were assigned. Significantly more time was spent per patient in individual sessions (1.25 hours) than in group education (0.74 hours).

CONCLUSION: Our data suggest that group education and counseling may confer similar benefits compared with traditional individual sessions. Additional investigation of this approach in larger numbers of patients is warranted.

Supported by National Cancer Institute; The Chief, Navy Bureau of Medicine and Surgery, Washington, DC, Clinical Investigation Program No. B99-015.

Authors' disclosures of potential conflicts of interest are found at the end of this article.