How to facilitate psychosocial adjustment in women tested for hereditary breast or ovarian cancer susceptibility? Insights from network analysis
Résumé
Background:Increasingly complex genetics counseling requires guidance to facilitatecounselees' psychosocial adjustment. We explored networks of inter-relationshipsamong coping strategies and specific psychosocial difficulties in women tested forhereditary breast or ovarian cancer.Methods:Of 752 counselees consecutively approached, 646 (86%) completed ques-tionnaires addressing coping strategies (Brief-COPE) and psychosocial difficulties(PAHC) after the initial genetic consultation (T1), and 460 (61%) of them again afterthe test result (T2). We applied network analysis comparing partial correlationsamong these questionnaire scales, according to the type of genetic test - single gene-targeted or multigene panel, test result and, before and after testing.Results:Overall, 98 (21.3%), 259 (56.3%), 59 (12.8%) and 44 (9.6%) women receiveda pathogenic variant, uninformative negative (panel testing), variant of uncertain sig-nificance (VUS) or true negative (targeted testing) result, respectively. In most net-works, connections were strongest between avoidance and general negativeemotions. Cognitive restructuring was inter-related to lower psychosocial difficulties.Avoidance and familial/social relationship difficulties were strongly related in womenreceiving a pathogenic variant. Stronger inter-relationships were also noticedbetween avoidance and worries about personal cancer and concerns about heredi-tary predisposition in women receiving a VUS result. Differences in the prominenceof inter-relationships were observed by type of testing and assessment time.Conclusions:Network analysis may be fruitful to highlight prominent inter-relationships among coping strategies and psychosocial difficulties, in women testedfor HBOC susceptibility, offering guidance for counseling.
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