The objective of the proposed study is to determine whether computer-based education is as effective as practitioner-based education for increasing understanding of genetic testing for breast cancer. For patients to make informed choices about genetic susceptibility testing for breast cancer, they need information about the meaning of test results, risks and benefits of screening, alternatives to genetic evaluation, and options for those with positive test results. This is particularly important with genetic susceptibility to breast cancer, since some proposed """"""""treatments"""""""" for positive test results (such as prophylactic bilateral mastectomy) are invasive, of profound impact, and unproven. Despite the need for information prior to screening, one-on-one education is costly, primary care practitioners are unlikely to have the time or specialized knowledge to counsel about the breast cancer gene, and genetic counselors are scarce. Practitioners could use a low cost, effective, reliable and acceptable method to provide information about genetic screening for breast cancer to patients. In other contexts, computers have been used successfully to disseminate medical information. It is not known, however, whether a computer approach to genetic education can effectively assist patients in making informed choices about genetic screening for breast cancer. The primary study hypothesis is that comprehension scores on a test of immediate recall of information about genetic screening for breast cancer will be as high for patients informed by computer-based education as by practitioner-based education. The secondary hypotheses are that knowledge will affect intent to receive testing and that computer-based education is less costly than practitioner-based education. We will test these hypotheses by a randomized controlled clinical trial using 150 women at high risk for familial breast cancer at two study sites. Consenting eligible subjects will be randomized to receive either education by computer or by genetic counselor. Immediately following the educational intervention, subjects will be given a multiple choice test of comprehension. Scores on this test will be measured, and group means will be compared. Intent to receive testing for the breast cancer susceptibility gene will be measured before and after the education intervention, and results will be compared to assess the effect of knowledge on intention to undergo genetic screening. Costs of computer- based education will be compared to practitioner-based education.
