Referral to cancer genetic counseling: Are there stages of readiness?

Suzanne M. O'Neill*, June A. Peters, Victor G. Vogel, Eleanor Feingold, Wendy S. Rubinstein

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

41 Scopus citations


As genetic awareness spreads among healthcare providers and the general public, and evidence mounts to show the efficacy of cancer control methods, referrals to cancer genetic counseling services for risk assessment are becoming more common. However, few studies have examined referral patterns to genetics and even less is known about referral uptake to clinical cancer genetic counseling. We investigated outcome of genetics referral in 43 affected women attending a breast cancer treatment program who were referred based on having BRCA mutation carrier risks ≥10%. Within 6 months, of the 36 women we were able to recontact, 13 (36%) came to an appointment at the cancer genetic counseling clinic (Acceptors), 10 (27%) said they intended to come in the future (Intenders), and 13(36%) said they would not consider genetic counseling (Decliners). Referral uptake was framed by elements of the Transtheoretical model (TTM) to determine if decisional balance scores (DBSs), a summary of an individual's "Pro" and "Con" opinions related to genetic testing, correlated with their decision to follow through. Mean DBS's were strongly negative for the Decliner group (-7.4), weakly negative for the Intender group (-1.1), and positive for the Acceptor group (5.4). The difference in the DBS along the continuum was due more to the mean "Con" score decreasing, rather than the mean "Pro" score increasing. Theoretical frameworks are needed to study adherence to referral for cancer genetic counseling. Stage-based theories may have a role to play.

Original languageEnglish (US)
Pages (from-to)221-231
Number of pages11
JournalAmerican Journal of Medical Genetics, Part C: Seminars in Medical Genetics
Issue number4
StatePublished - Nov 15 2006


  • Adherence
  • Breast cancer
  • Cancer genetic counseling
  • Genetic testing
  • Oncology
  • Psychology
  • Referral
  • Risk assessment
  • Stages of change
  • Transtheoretical model

ASJC Scopus subject areas

  • Genetics(clinical)
  • Genetics


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