- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03225170
Is it Feasible?: Self-Affirmation for Hereditary Breast and Ovarian Cancer Genetic Counseling
Background:
Some women have a high chance of developing breast and ovarian cancer because of a change in a gene that is passed within a family from one generation to the next. These women with hereditary breast and ovarian cancer (HBOC) have to make hard choices about tests and treatments. Researchers want to study how to help women to feel ready to make those choices. A kind of writing exercise might help if it is done before genetic counseling. This writing exercise is called a self-affirmation (SA) exercise. It may lead to better communication during counseling and better behavioral outcomes.
Objective:
To see if an SA exercise done before HBOC genetic counseling could improve client communication and behavior.
Eligibility:
- Clients: Adult female >=18 years of age with initial appointment for HBOC risk with genetic counselor at St. Luke's Health System
- Genetic Counselors: Genetic counselors >=18 years of age providing genetic counseling to clients at risk for HBOC
Design:
Clients will be screened by phone prior to their genetic counseling appointment.
They will arrive 15 minutes early to their appointment.
They will do a 10 to 15 minute survey and writing exercise. This includes questions about:
- Things that are important to them
- How they are feeling prior to the appointment
After their genetic counseling appointment, they will take a 10- to 15-minute follow-up survey. It can be in the office or online. It will include questions about:
- How they felt about the writing exercise
- How they felt about their genetic counseling
- If they had cancer
- If they were offered and had genetic testing
Genetic counselor participants will take a 2 to 5 minute survey after each session with a client in the study. This will include questions about how the client was in the session. They also will take a 10 to 15 minute survey at the end of the study. It will be about their opinions on the process of having their clients complete the writing exercise.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
The proposed study is a feasibility study to assess the viability of implementing a Self-Affirmation (SA) intervention in a Hereditary Breast and Ovarian Cancer (HBOC) genetic counseling clinic to improve client communication and behavioral outcomes. Participants will be clients and genetic counselors at the St. Luke's Hospital System HBOC clinic. This study seeks to identify outcomes that would be most informative in a large-scale research protocol. As outcomes, we will assess clients' decision self-efficacy, intention to talk with family, genetic test uptake, empowerment, and HBOC knowledge. We will also assess genetic counselors' and clients' perceived benefits, perceived harms, and acceptance of the affirmation intervention.
In this study clients will be invited to participate in an intervention before their genetic counseling appointment. The SA intervention is a short written exercise to reinforce clients' self-integrity (a global sense of personal adequacy) leading to more openness to threatening information within the genetic counseling session. Clients and genetic counselors will be surveyed to assess outcome measures and feasibility of the intervention.
Social science research has shown that when people are faced with threatening information they often seek to protect themselves and reject the threatening message. Message rejection can include minimizing the importance or discrediting the truth of the message. SA interventions aim to bolster self-integrity or esteem by focusing on aspects of participants' lives they value and thereby improving participants' self-perception and tolerance towards threatening messages. SA manipulations have been shown to increase patient communication within appointments and both intentions and actions toward behavior change.
Often in cancer genetic counseling appointments clients are confronted with the threat of having a significantly increased risk for cancers while being asked to make a decision about genetic testing. A self-affirmation intervention may facilitate greater client decision self-efficacy, empowerment, and positive behavior outcomes, such as communication with family regarding genetic risk and screening behaviors.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
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Missouri
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Kansas City, Missouri, United States, 64111
- St. Luke's Health System
-
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
INCLUSION CRITERIA:
Client Participants:
- Must be female, at least 18 years old
- Have an initial appointment for genetic counseling for HBOC risk at St. Luke's Health System
- Must be able to read and write in English to participate
- Pregnant women will be included
Genetic Counselor (GC) Participants:
-Must be certified GCs who see clients with an indication for HBOC related genetic counseling at St. Luke's Health System
EXCLUSION CRITERIA:
- Non-English speakers and illiterate subjects will be excluded
- Clients who are unable to provide consent will be excluded
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Health Services Research
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Double
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Self-affirmation (SA) group
Immediately prior to the scheduled cancer genetic counseling appointment, clients:
|
Clients will be asked to rank artistic skills, athletics, business/money, creativity, independence, music, politics, relationships with friends and family, religious values, sense of humor, spontaneity from most important to least important.
They will then be asked to write about the item that is most important to them and why it may be important to them.
|
Sham Comparator: Control group
Immediately prior to the scheduled cancer genetic counseling appointment, clients:
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Clients will be asked to rank artistic skills, athletics, business/money, creativity, independence, music, politics, relationships with friends and family, religious values, sense of humor, spontaneity from most important to least important.
The control group will rank the list and be asked to write about the 9th ranked item and why it might be important to someone else.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Test Uptake: Number of Clients Who Indicated Intention to Have Genetic Testing
Time Frame: Assessed within 1 week after completing the genetic counseling session
|
Intention to have genetic testing was measured with a single survey item, "Do you plan to have genetic testing?" with response options of yes=1; maybe=2; no=3
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Assessed within 1 week after completing the genetic counseling session
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Number of Clients Who Indicated "Intention to Talk With Family" About Genetic Testing Result
Time Frame: Assessed within 1 week after completing the genetic counseling session
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Intention to talk with family was measured with a single categorical survey item, "Which best describes your plans to talk with your family members about genetic testing results (check the one answer that is most true for you)?"
|
Assessed within 1 week after completing the genetic counseling session
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Likelihood of Talking With Family Members
Time Frame: Assessed within 1 week after completing the genetic counseling session
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Likelihood of talking with family members was measured with a single survey item on a 7 point scale, "How likely are you to share results with the relatives you selected?" with 1= Extremely unlikely; 7=Extremely likely
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Assessed within 1 week after completing the genetic counseling session
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Decision Self-efficacy: Ability to Confidently Make Decision About Genetic Testing
Time Frame: Assessed within 1 week after completing the genetic counseling session
|
Decision Self-efficacy was measured with the 12 item Decision Self-efficacy Scale by O'Connor, 1995.
Scores ranged from 1-5 with higher average scores indicating higher decision self-efficacy
|
Assessed within 1 week after completing the genetic counseling session
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Client Knowledge: Hereditary Breast and Ovarian Cancer (HBOC) Knowledge Post Counselling Session
Time Frame: Assessed within one week after completing the genetic counseling session
|
Hereditary Breast and Ovarian Cancer (HBOC) Knowledge was measured with an adapted 7-question scale based on the National Center for Human Genome Research Knowledge (NCHGRK) Scale [Scherr et al. 2015; Kaphingst et al. 2012].
All questions in the scale were presented as True/False.
Each question in the scale had a correct answer (coded as 1) and incorrect answer (coded as 0).
This adapted HBOC Knowledge Scale score was calculated by summing the total value across the seven questions, with a range of 0 (minimum score, all incorrect) to 7 (maximum score, all correct).
Higher score indicates higher knowledge.
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Assessed within one week after completing the genetic counseling session
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Patient Empowerment (Client Completed): Ability to Manage Information and Risk Associated With Hereditary Breast and Ovarian Cancer (HBOC) (Decisional Control, Cognitive Control, Behavioral Control, Emotional Regulation, and Hope)
Time Frame: Assessed within one week after completing the genetic counseling session
|
Patient empowerment (client completed) was measured with the 24 item Genetic Counseling Outcomes Scale (GCOS-24; McAllister et al, 2011) using 7-point score ranging from 1=strongly disagree to 7= strongly agree.
Higher scores indicate higher empowerment.
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Assessed within one week after completing the genetic counseling session
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Patient Empowerment (Genetic Counselor Completed): Client's Ability to Manage Information and Risk Associated With HBOC (Decisional Control, Cognitive Control, Behavioral Control, Emotional Regulation, and Hope)
Time Frame: Assessed immediately after completing the genetic counseling visit
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Patient empowerment (genetic counselor completed) was measured with the 24 item Genetic Counseling Outcomes Scale (GCOS-24; McAllister et al, 2011) using 7-point score ranging from 1=strongly disagree to 7= strongly agree.
Higher scores indicate higher empowerment
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Assessed immediately after completing the genetic counseling visit
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Mammogram Intention After Counseling: Likelihood of Getting a Mammogram
Time Frame: Assessed within one week after completing the genetic counseling session
|
Mammogram intention was measured with a single survey item on a 7 point scale "How likely are you to get regular mammograms?" with 1= Extremely unlikely to 7=Extremely likely
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Assessed within one week after completing the genetic counseling session
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Client Anxiety After Writing Exercise and Prior to Counseling
Time Frame: Assessed immediately after completing the writing exercise and prior to the genetic counseling session
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Patient anxiety was measured using the 6 item short version of the Spielberger State Anxiety Scale, a 4-point scale; 1= not at all, 2=somewhat, 3=moderately, 4= very much.
Higher score indicates higher anxiety
|
Assessed immediately after completing the writing exercise and prior to the genetic counseling session
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Perceived Effect of Writing Exercise on Genetic Counseling Visit: Number of Clients With Perceived Effect of Intervention After Writing Exercise
Time Frame: Assessed within one week after completing the genetic counseling session
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Perceived effect of writing exercise on genetic counseling visit was measured using a single item "The values writing activity affected my appointment"; 1=yes; 2=no
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Assessed within one week after completing the genetic counseling session
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Perception That Writing Exercise Hindered Genetic Counseling Visit: Number of Clients
Time Frame: Assessed within one week after completing the genetic counseling session
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Perception that writing exercise hindered the genetic counseling visit was measured using a single survey item "The values writing activity hindered my interaction with my genetic counselor"; 1=yes; 2=no
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Assessed within one week after completing the genetic counseling session
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Perception That Intervention Improved Genetic Counseling Visit: Number of Clients
Time Frame: Within 1 week after completing the genetic counseling session
|
Perception that intervention improved the genetic counseling visit was measured using a single survey item "The values writing activity improved my interaction with my genetic counselor"; 1=yes; 2=no
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Within 1 week after completing the genetic counseling session
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Level of Engagement With the Writing Exercise: Number of Words in Writing Intervention
Time Frame: At the time of the intervention
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Number of words in writing intervention was measured by counting the number of words in the essay written by the client
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At the time of the intervention
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Level of Engagement With the Writing Exercise: Number of Words in Writing Intervention Discussing Importance of Selected Value
Time Frame: At the time of the intervention
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Number of Words in Writing Intervention Discussing Importance of Selected Value was measured by counting the number of words in the essay written by the client that were in phrases that were focused on discussing the importance of the selected value, as coded by two coders.
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At the time of the intervention
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Level of Engagement With the Writing Exercise: Number of Words in Writing Intervention Discussing How Value Was Recently Used
Time Frame: At the time of the intervention
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Number of Words in Writing Intervention Discussing How Value Was Recently Used was measured by counting the number of words in the essay written by the client that were in phrases that were focused on discussing how the value was recently used.
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At the time of the intervention
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Level of Engagement With the Writing Exercise: Number of Examples of How Value Was Recently Used
Time Frame: At the time of the intervention
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Number of Examples of How Value was Recently Used was measured by counting the number of unique examples offered in the essay as coded by two coders.
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At the time of the intervention
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Level of Engagement With the Writing Exercise: Essay Attitude Strength
Time Frame: At the time of the intervention
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Essay Attitude Strength is a measure of the extent to which the participant's essay demonstrated the importance of the value selected during the writing exercise.
Two independent raters read a subset of the essays and used a scoring system based on the procedure described in Harris & Napper (2005).
Each rater gave the participant's essay a numeric score between 1 and 7, and the two scores were examined for inter-rater reliability.
The primary rater then rated the remaining essays and the final score was the rating assigned by the primary rater for all essays.
A score of 1 (minimum) indicated that the selected value appeared to be not at all important to the participant.
A score of 7 (maximum) indicated that the selected value appeared to be very important to the participant.
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At the time of the intervention
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Level of Engagement With the Writing Exercise: Self-affirmation Score
Time Frame: At the time of the intervention
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Self-affirmation score is a measure of the extent to which the essay appeared to be self-affirming for the participant.
Two independent raters scored a subset of essays using a system based on procedures described in Harris & Napper (2005) and Ferrer et al. (2017) using the following instructions: "Setting aside your own opinions and values, how self-affirmed would you estimate the writer of this passage to have been (at the end)?" Raters scored each essay and the two scores were examined for inter-rater reliability.
The primary rater then rated the remaining essays and the final score was the rating assigned by the primary rater for all essays.
A score of 1 (minimum) indicated the value was important but did not include descriptions of why the value was important to the participant.
A control group participant received a score of 1 if they followed the writing activity's instructions exactly.
A score of 5 (maximum) indicated that the essay elaborated on why the value was important.
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At the time of the intervention
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Collaborators and Investigators
Publications and helpful links
General Publications
- Scherr CL, Christie J, Vadaparampil ST. Breast Cancer Survivors' Knowledge of Hereditary Breast and Ovarian Cancer following Genetic Counseling: An Exploration of General and Survivor-Specific Knowledge Items. Public Health Genomics. 2016;19(1):1-10. doi: 10.1159/000439162. Epub 2015 Sep 22.
- Kaphingst KA, Facio FM, Cheng MR, Brooks S, Eidem H, Linn A, Biesecker BB, Biesecker LG. Effects of informed consent for individual genome sequencing on relevant knowledge. Clin Genet. 2012 Nov;82(5):408-15. doi: 10.1111/j.1399-0004.2012.01909.x. Epub 2012 Aug 7.
- Harris PR, Napper L. Self-affirmation and the biased processing of threatening health-risk information. Pers Soc Psychol Bull. 2005 Sep;31(9):1250-63. doi: 10.1177/0146167205274694.
- Ferrer RA, Klein WM, Graff KA. Self-affirmation increases defensiveness toward health risk information among those experiencing negative emotions: Results from two national samples. Health Psychol. 2017 Apr;36(4):380-391. doi: 10.1037/hea0000460. Epub 2017 Feb 16.
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Skin Diseases
- Neoplasms
- Urogenital Neoplasms
- Neoplasms by Site
- Genital Neoplasms, Female
- Endocrine System Diseases
- Ovarian Diseases
- Adnexal Diseases
- Gonadal Disorders
- Endocrine Gland Neoplasms
- Breast Diseases
- Genetic Diseases, Inborn
- Neoplastic Syndromes, Hereditary
- Ovarian Neoplasms
- Breast Neoplasms
- Hereditary Breast and Ovarian Cancer Syndrome
Other Study ID Numbers
- 999917132
- 17-HG-N132
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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