A scalable new model of germline cancer genomic care delivery: Assessing psychological outcomes.

Abstract

New care models promise to increase access to germline genetic testing. To decrease testing gaps, we offered universal germline testing without pretest genetic counseling to unselected patients at a comprehensive cancer center. To address safety concerns over the elimination of pretest counseling, we examined detrimental psychological impact (DPI) after participants underwent testing in this novel model. We assessed participants' genomic testing-specific DPI using the Feelings About Genomic Testing Results instrument (2-weeks/6-months after disclosure). Overall DPI, negativity, uncertainty, positivity, and privacy concerns were assessed. We used chi-square, analysis of covariance multivariable regression, and mediation analysis to examine relationships between variables. A total of 846 participants completed the survey. Most participants (96.0%) exhibited low DPI, negativity (95.6%), uncertainty (94.0%), and concerns about privacy (95.6%) and high positivity (55.6%). Participants with cancer had higher negativity and uncertainty than those without. DPI significantly diminished over time in participants with positive tests. Overall DPI was low, demonstrating that most participants are at minimal psychological risk when receiving germline results without pre-test counseling. However, a small subset of participants exhibit high distress and uncertainty. Additional efforts are needed to identify at-risk participants receiving universal testing who would benefit from interventions aimed at mitigating DPI.