The influence of dispositional optimism on post-visit anxiety and risk perception accuracy among breast cancer genetic counselees

Evaluation of psychosocial aspects in participants of cancer genetic counseling

Background

The instrument called “Hospital Anxiety and Depression Scale” (HADS) is frequently used to evaluate anxious and depressive symptomatology in patients who receive Cancer Genetic Counseling (CGC). However, this instrument cannot identify all of the psychosocial factors, such as the antecedents of the patients’ emotional states or their concerns. The objective of the present research was to compare cases detected with psychosocial alterations by means of HADS and a Psychological Health Interview (PHI).

Methods

A transversal analytical design was used. One hundred ten participants were included (97.3% females and 2.7% males). The average age was 45 years ±10 years.

Results

The PHI identified twice the amount of participants with psychosocial alterations than did HADS, which only detected 43% of these participants.

Conclusions

The results of our study suggest that the PHI should be applied in addition to HADS to identify participants who would require psychological support due to recurrent concerns.

A Cognitive-Affective Scale for Hurricane Risk Perception

The aim of this study was to develop a reliable and valid measure of hurricane risk perception. The utility of such a measure lies in the need to understand how people make decisions when facing an evacuation order. This study included participants located within a 15-mile buffer of the Gulf and southeast Atlantic U.S. coasts. The study was executed as a three-wave panel with mail surveys in 2010-2012 (T₀ baseline N = 629, 56%; T₁ retention N = 427, 75%; T₂ retention N = 350, 89%). An inventory based on the psychometric model was developed to discriminate cognitive and affective perceptions of hurricane risk, and included open-ended responses to solicit additional concepts in the T₀ survey. Analysis of the T₀ data modified the inventory and this revised item set was fielded at T₁ and then replicated at T₂ . The resulting scales were assessed for validity against existing measures for perception of hurricane risk, dispositional optimism, and locus of control. A measure of evacuation expectation was also examined as a dependent variable, which was significantly predicted by the new measures. The resulting scale was found to be reliable, stable, and largely valid against the comparison measures. Despite limitations involving sample size, bias, and the strength of some reliabilities, it was concluded that the measure has potential to inform approaches to hurricane preparedness efforts and advance planning for evacuation messages, and that the measure has good promise to generalize to other contexts in natural hazards as well as other domains of risk.

Combined and Relative Effect Levels of Perceived Risk, Knowledge, Optimism, Pessimism, and Social Trust on Anxiety among Inhabitants Concerning Living on Heavy Metal Contaminated Soil

This research aims at combined and relative effect levels on anxiety of: (1) perceived risk, knowledge, optimism, pessimism, and social trust; and (2) four sub-variables of social trust among inhabitants concerning living on heavy metal contaminated soil. On the basis of survey data from 499 Chinese respondents, results suggest that perceived risk, pessimism, optimism, and social trust have individual, significant, and direct effects on anxiety, while knowledge does not. Knowledge has significant, combined, and interactive effects on anxiety together with social trust and pessimism, respectively, but does not with perceived risk and optimism. Social trust, perceived risk, pessimism, knowledge, and optimism have significantly combined effects on anxiety; the five variables as a whole have stronger predictive values than each one individually. Anxiety is influenced firstly by social trust and secondly by perceived risk, pessimism, knowledge, and optimism. Each of four sub-variables of social trust has an individual, significant, and negative effect on anxiety. When introducing four sub-variables into one model, trust in social organizations and in the government have significantly combined effects on anxiety, while trust in experts and in friends and relatives do not; anxiety is influenced firstly by trust in social organization, and secondly by trust in the government.

Improved health perception after genetic counselling for women at high risk of breast and/or ovarian cancer: construction of new questionnaires--an Italian exploratory study

BACKGROUND

Subjects referred to genetic counselling for cancer may have heightened perceptions of illness and death, even though they are healthy and this may cause anxiety and reluctance to follow through with consultation. We investigated such perceptions before and after counselling and genetic testing for cancer in a cohort of Italian women. We sought to understand the situation of the women referred by designing questionnaires administered to women at high risk of breast and/or ovarian cancer (those who had had a pathogenic mutation identified in a family member via diagnostic testing). We also assessed women after the diagnosis of breast cancers, but free of disease, to help determine risks in their families.

METHODS

The first questionnaires were administered before initial counselling, and the second were completed within 20 days after the counselling. When a genetic test was proposed, the individual was asked to fill in a third questionnaire; the final questionnaire was administered after the person had received the results of the genetic test.

RESULTS

We evaluated 204 subjects. Before counselling, 89 % of the subjects were worried about their risk of disease, 52 % felt "different" because of their personal and family history, and 39 % declared that their life choices were influenced by their fear of cancer. After counselling, 82 % of the subjects felt more relived about their pre-existing fears and stated that this process of being seen in a clinic with genetic expertise had clarified the meaning of disease risk for them, and for 50 %, this experience had positively influenced their life choices. Thirty percentage of the subjects had a positive test; all of them felt safer in being cared for by specifically trained staff. Fifty percentage had a less informative test (e.g. "wild-type" gene found); 84 % of them were not worried by the uncertainty, and overall, 96 % considered counselling to be very useful.

CONCLUSION

Candidates for genetic counselling frequently had heightened their perception of being ill, which influenced their ability to make life decisions. Genetic counselling often improves this perception, especially in subjects who have negative tests and this knowledge facilitates their life plans. After testing, most women felt satisfied and safer because of being properly followed by professionally trained and sympathetic staff. In conclusion, knowledge of the real individual risk, the presence of a professional team, and the possibility of entering a programme of controlled screening enable patients rather than living in fear and uncertainty to be less anxious about their state of health and to live with the knowledge that they are doing everything possible to care for themselves, aided by a specialized team, and that, if necessary, they would be able to take part in investigational studies.