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Systematic evidence review and meta-analysis of outcomes associated with cancer genetic counseling. | LitMetric

Systematic evidence review and meta-analysis of outcomes associated with cancer genetic counseling.

Genet Med

Division of Gastroenterology, Department of Medicine and Division of Epidemiology, Department of Population Health Sciences, Weill Cornell Medicine, New York, NY.

Published: January 2024

AI Article Synopsis

  • Genetic counseling (GC) is important in assessing genetic cancer risk, but there is a need for thorough review of published studies to ensure effective implementation.
  • A systematic review of 25 out of 5,393 articles found limited evidence supporting the post-test outcomes of GC, while pre-test GC showed some benefits like reduced worry and increased knowledge among patients.
  • The overall quality of evidence regarding the impact of GC on health-related outcomes is low, highlighting the need for further research to establish its effectiveness in genetic cancer risk assessment.

Article Abstract

Purpose: Genetic counseling (GC) is standard of care in genetic cancer risk assessment (GCRA). A rigorous assessment of the data reported from published studies is crucial to ensure the evidence-based implementation of GC.

Methods: We conducted a systematic review and meta-analysis of 17 patient-reported and health-services-related outcomes associated with pre- and post-test GC in GCRA in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology.

Results: Twenty-five of 5393 screened articles met inclusion criteria. No articles reporting post-test GC outcomes met inclusion criteria. For patient-reported outcomes, pre-test GC significantly decreased worry, increased knowledge, and decreased perceived risk but did not significantly affect patient anxiety, depression, decisional conflict, satisfaction, or intent to pursue genetic testing. For health-services outcomes, pre-test GC increased correct genetic test ordering, reduced inappropriate services, increased spousal support for genetic testing, and expedited care delivery but did not consistently improve cancer prevention behaviors nor lead to accurate risk assessment. The GRADE certainty in the evidence was very low or low. No included studies elucidated GC effect on mortality, cascade testing, cost-effectiveness, care coordination, shared decision making, or patient time burden.

Conclusion: The true impact of GC on relevant outcomes is not known low quality or absent evidence. Although a meta-analysis found that pre-test GC had beneficial effects on knowledge, worry, and risk perception, the certainty of this evidence was low according to GRADE methodology. Further studies are needed to support the evidence-based application of GC in GCRA.

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.gim.2023.100980DOI Listing

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