Decision coaching for healthy women with BRCA1/2 pathogenic variants and open family planning: Impact on decisional conflict and decision status: Subgroup analyses from a randomized controlled trial.

Constitutional pathogenic variants in BRCA1 or BRCA2 in women without a personal history of cancer.

This exploratory study reports subgroup analyses from a randomised controlled trial of a decision coaching programme — in-person coaching plus an evidence-based structured decision aid covering intensified breast surveillance, risk-reducing bilateral mastectomy and risk-reducing bilateral salpingo-oophorectomy — in women carrying a pathogenic variant in BRCA1 or BRCA2 without a personal cancer history, compared with usual care. Data were collected at baseline, 12 weeks and 6 months using the Decisional Conflict Scale (DCS) and the Status of Decision-Making Scale, comparing women with open versus completed family planning. At baseline, women with open family planning had higher decisional conflict (mean total DCS score 39.5 vs 34.4; mean difference -5.12; 95% CI [-9.328; -0.977]; p = 0.018). Decisional conflict fell considerably more in the intervention group than in the control group, and the reduction was greater in women with open family planning. Among initially undecided women with open family planning, 61.8% in the intervention group had reached a preventive decision at 12 weeks versus 23.3% in the control group (p < 0.001), and they significantly more often chose intensified breast surveillance.

Synthesis written by Geno'X. For the full original abstract, please refer to the source publication.

The demonstrated effect concerns decision-process outcomes, not health outcomes: we learn that these women decide faster and with less conflict, not that the decision they make is the right one for them or that it holds beyond 6 months. These are exploratory subgroup analyses whose sample sizes are not reported in the abstract, and the more frequent choice of intensified breast surveillance should be confirmed on a prespecified endpoint before being attributed to the intervention. The programme is transferable to cancer genetics clinics, provided one accepts the dedicated consultation time and training it requires.

Analysis by Dr Thibaut Benquey