Genetic testing research for inherited cancer susceptibility, based on the recently identified BRCA1 and 2 genes, will soon confront many healthy women with the option of receiving feedback about their breast and ovarian cancer prospects. This information can have profound psychosocial consequences which ultimately undermine adjustment and health-protective behaviors. A truly informed decision with regard to participation in genetic testing research must therefore take into account the full range of consequences that it entails for a given individual. The proposed study (N=300) of women at high familial risk for breast and ovarian cancer aims to develop and assess a core intervention, based on state-of-the-art theory and research, to facilitate well-informed decisions for BRCA1/2 testing. In this procedure, the genetic cancer testing candidate is helped to cognitively and emotionally anticipate scenarios about alternative potential outcomes of testing outlined in the informed consent process. The goal is to enable the individual to vividly imagine the personal and social impact on herself and her future, in the context of a brief, structured supportive counseling session. The utility of this Cognitive-Affective Preparation (CAP) procedure will be evaluated systematically, in a randomized controlled trial, with General Health Information (GHI) serving as a control condition. Outcome measures include: the depth, complexity, and accuracy of information-processing, and decisions about, and evaluation of, participation in genetic testing; adjustment (i.e., intrusive and avoidant ideation, affect, quality of life) and adherence to recommended cancer-protective behaviors. In addition, the study explores the influence of characteristic individual differences in styles of coping with health threats, focusing on the impact of high monitoring (i.e., scanning for cancer-related cues) vs. low monitoring (i.e., distraction from cancer-related cues) on information processing, on the genetic testing decision and on adaptation to the consequences. Assessments will be obtained at baseline, after standard care, after CAP or GHI, after pre-disclosure and disclosure of results, and at 1-2 week and 6-month follow-up intervals.
