Racial differences in testing motivation and psychological distress following pretest education for BRCA1 gene testing

Objectives. We conducted a randomized trial to investigate racial differenc es in response to two alternate pretest education strategics for BRCA1 gene tic testing: a standard education model and an education plus counseling (E +C) model. Materials and Methods. Two hundred twenty-eight Caucasian women and 70 Afri can American women with a family history of breast or ovarian cancer were c ontacted for a baseline telephone interview to assess sociodemographic char acteristics, number of relatives affected with cancer, and race before pret est education. Outcome variables included changes from baseline to 1-month follow-up in cancer-related distress and genetic testing intentions, as wel l as provision of a blood sample after the education session. Results. African American women were found to differ significantly from Cau casian women in the effects of the interventions on testing intentions and provision of a blood sample. Specifically, in African American women, E+C l ed to greater increases than education only in intentions to be tested and provision of a blood sample. These effects were independent of socioeconomi c status and referral mechanisms. In Caucasian women, there were no differe ntial effects of the interventions on these outcomes. Reductions in cancer- specific distress a ere evidenced in all study groups. However, this decrea se, although not significantly different, was smallest among African Americ an women who received E+C, Conclusions. In low- to moderate-risk African American women, pretest educa tion and counseling may motivate BRCA1 testing. Further research is needed to explore the mechanisms of impact of the alternate pretest education stra tegies and to increase the cultural sensitivity of education and counseling protocols.