Abstract

A Biopsychosocial Approach to the Analysis of Cancer Genetics Communication

PI: Lee Ellington
W.N. Dudley, Statistician

In stark contrast to the technological sophistication of cancer predictive testing, little is currently known about how the knowledge gained in predictive testing is communicated within clinical genetics or how this knowledge impacts consumer behavior. In short, technology is quickly outpacing our ability to use the information gained in predictive testing to modify the cancer screening behaviors which are so critical for early detection and cure.

Two projects are proposed to study the communication processes of cancer clinical genetics and its impact on client adjustment. It is likely that clients process genetic testing information within a context of psychological, physiological, and social factors. To frame the work, a model will be used that takes into account multiple facets of provider/client communication. The model includes client and provider antecedent factors (i.e., individual differences in distress), the nature of the communication exchange (as measured by a medical coding system) and physiologic correlates (e.g., heart rate and skin conductance), and client outcomes (e.g., psychological adaptation).

The aims for both studies are threefold: to (1) examine the impact of individual differences on psychophysiologic responsivity and on session communication (content and process); (2) examine the impact of specific communication patterns on physiological responsivity, and (3) examine the impact of communication on client response and adjustment.

Project 1 will enlarge the goals of an existing, funded project, "Genetic Counselor Process and Analogue Client Response," under the direction of Dr. Debra Roter at Johns Hopkins. Within this project, the impact of cancer genetic counselors' communication on the responses of analogue clients will be studied. A unique component to the goals of the existing parent project will be added by examining how counselor differences in the expression of distress affects analogue client's physiologic responsivity, subjective measures of distress, recall, and impressions of the counseling process. Whereas the aims of Project 1 are to study the impact of the communication variability of cancer genetic counselors on analogue client responses; the aims of Project 2 will study the impact of individual differences of actual cancer clinical genetics clients on communication and physiologic responsivity during appointments, as well as reactions immediately following. Thus, Project 2 will serve as clinical validation of the parent project and Project 1.

By studying these factors and their related pathways, the "active ingredients" in clinical genetics communication can be identified which predict client adjustment and cancer screening utilization. It is critical to develop more effective approaches for the communication of inherited risk information and screening recommendations to increase client early detection and, thus, decrease cancer mortality and morbidity rates.