***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: ABSTRACT Despite increased interest among the public in breast cancer genetic risk and genetic testing , there are limited services to help women make informed decisions about genetic testing . This study , conducted with female callers ( N = 279 ) to the National Cancer Institute 's ( NCI 's ) Atlantic Region Cancer Information Service ( CIS ) , developed and evaluated a theory-based , educational intervention design ed to increase callers ' underst and ing of the following : ( a ) the kinds of information required to determine inherited risk ; ( b ) their own personal family history of cancer ; and ( c ) the benefits and limitations of genetic testing . Callers requesting information about breast/ovarian cancer risk , risk assessment services , and genetic testing were r and omized to either : ( 1 ) st and ard care or ( 2 ) an educational intervention . Results show that the educational intervention reduced intention to obtain genetic testing among women at average risk and increased intention among high-risk women at 6 months . In addition , high monitors , who typically attend to and seek information , demonstrated greater increases in knowledge and perceived risk over the 6-month interval than low monitors , who typically are distracted from information . These findings suggest that theoretically design ed interventions can be effective in helping women underst and their cancer risk and appropriate risk assessment options and can be implemented successfully within a service program like the CIS This r and omised controlled trial evaluated the impact of an enhanced counselling ( EC ) intervention on knowledge about the heritability of breast and ovarian cancer and distress , as a function of BRCA test result , among high-risk women . Before deciding about whether or not to undergo genetic testing , participants were r and omly assigned to the  EC intervention ( N = 69 ) , design ed to promote cognitive and affective processing of cancer risk information ( following the st and ard individualised counselling session ) , or to the control condition ( N = 65 ) , which involved st and ard individualised counselling followed by a general health information session to control for time and attention . Women in the EC group exhibited greater knowledge than women in the control group , 1 week after the intervention . Further , at the affective level , the intervention was found to be the most beneficial for women testing positive : specifically 1 week after test result disclosure , women in the intervention group who tested positive experienced lower levels of distress than women in the control group who tested positive . The findings suggest that the design of counselling aids should include a component that explicitly activates the individual 's cognitive – affective processing system Background : Limited empirical data are available on the effects of genetic counseling and testing among African American women . Objective : To evaluate the effects of genetic counseling and testing in African American women based on different levels of exposure : ( a ) women who were r and omized to culturally tailored ( CTGC ) and st and ard genetic counseling ( SGC ) to women who declined r and omization ( non-r and omized group ) , ( b ) participants and non- participants in genetic counseling , and ( c ) BRCA1 and BRCA2 ( BRCA1/2 ) test result acceptors and decliners . Design : R and omized trial of genetic counseling conducted from February 2003 to November 2006 . Measures : We evaluated changes in perceived risk of developing breast cancer and cancer worry . Results : Women r and omized to CTGC and SGC did not differ in terms of changes in risk perception and cancer worry compared to decliners . However , counseling participants had a significantly greater likelihood of reporting reductions in perceived risk compared to non- participants ( p = 0.03 ) . Test result acceptors also had a significantly greater likelihood of reporting decreases in cancer worry ( p = 0.03 ) . However , having a cancer history ( p = 0.03 ) and a BRCA1/2 prior probability ( p = 0.04 ) were associated with increases in cancer worry . Conclusions : Although CTGC did not lead to significant improvements in perceived risk or psychological functioning , African American women may benefit from genetic counseling and testing . Continued efforts should be made to increase access to genetic counseling and testing among African American women at increased risk for hereditary disease . But , follow-up support may be needed for women who have a personal history of cancer and those with a greater prior probability of having a BRCA1/2 mutation OBJECTIVES This paper examines the knowledge , opinions , and predictors of interest in genetic testing for breast cancer risk in a demographically diverse group of women in western Washington who participated in a r and omized controlled trial ( RCT ) of breast cancer risk counseling methods . MATERIAL S AND METHODS Four groups of women were surveyed , all with some family history of breast cancer : ( a ) 307 white women ; ( b ) 36 African-American women ; ( c ) 87 lesbian/bisexual women ; and ( d ) 113 Ashkenazi Jewish women . As part of the baseline question naire for the RCT , participants were asked about their familiarity with genetic testing for breast cancer risk , their interest in such testing and opinions of it , and actions they anticipated based on test results . RESULTS Women in all four groups favored ready access to testing , believed the decision to be tested should be a personal choice , believed that genetic test results should stay confidential , and were not greatly concerned that this might not be possible . Women anticipated using such genetic test results to increase the frequency of various breast cancer screening methods ( in all four groups , > 69 % would increase mammogram frequency , > 85 % would increase clinician exam , and > 92 % would increase breast self exam ) . Women overwhelmingly rejected prophylactic surgery as a preventive measure ( in all > 80 % probably or definitely would not consider it ) . Significant predictors of interest in genetic testing for cancer risk included perceived risk , cancer worry , and beliefs about access to testing . CONCLUSIONS These data will be of interest to health care providers , payers , public health professionals , legislators , and others as they consider issues associated with population testing for susceptibility to common diseases such as breast cancer OBJECTIVES We conducted a r and omized trial to investigate racial differences in response to two alternate pretest education strategies for BRCA1 genetic testing : a st and ard education model and an education plus counseling ( E + C ) model . MATERIAL S AND METHODS Two hundred twenty-eight Caucasian women and 70 African American women with a family history of breast or ovarian cancer were contacted for a baseline telephone interview to assess sociodemographic characteristics , number of relatives affected with cancer , and race before pretest education . Outcome variables included changes from baseline to 1-month follow-up in cancer-related distress and genetic testing intentions , as well as provision of a blood sample after the education session . RESULTS African American women were found to differ significantly from Caucasian women in the effects of the interventions on testing intentions and provision of a blood sample . Specifically , in African American women , E + C led to greater increases than education only in intentions to be tested and provision of a blood sample . These effects were independent of socioeconomic status and referral mechanisms . In Caucasian women , there were no differential effects of the interventions on these outcomes . Reductions in cancer-specific distress were evidence d in all study groups . However , this decrease , although not significantly different , was smallest among African American women who received E + C. CONCLUSIONS In low- to moderate-risk African American women , pretest education and counseling may motivate BRCA1 testing . Further research is needed to explore the mechanisms of impact of the alternate pretest education strategies and to increase the cultural sensitivity of education and counseling protocol OBJECTIVE The objective of this study was to evaluate satisfaction with genetic counseling for BRCA1 and BRCA2 ( BRCA1/2 ) mutations among African American women . METHODS Participants were 54 African American women at moderate and high risk for BRCA1/2 mutations who were offered genetic testing as part of a r and omized clinical trial design ed to compare the effects of culturally tailored genetic counseling ( CTGC ) and st and ard genetic counseling ( SGC ) . Satisfaction with genetic counseling was evaluated using a self-administered question naire following culturally tailored or st and ard pre-test education and counseling . RESULTS Overall , the majority of women ( 96 % ) were very satisfied with genetic counseling ; however , only 26 % reported that their worries were lessened and 22 % reported that they were able to cope better . Women who received CTGC were significantly more likely than women who received SGC to report that their worries were lessened ( p<0.05 ) . In addition , women with household incomes less than US$ 35,000 were significantly more likely to report that the counselor lessened their worries compared to women with higher incomes ( p<0.05 ) . CONCLUSIONS Most African American women were satisfied with genetic counseling ; however , women who received culturally tailored genetic counseling were significantly more likely to strongly agree that their worries were lessened compared to women who received st and ard genetic counseling . PRACTICE IMPLICATION S Discussion of cultural beliefs and values during genetic counseling may be beneficial to African American women , especially those with low incomes Low rates of genetic counseling among African American women have generated concerns about disparities ; however , to the extent that women ’s decisions to accept or decline counseling are consistent with their values , then lower participation may reflect preferences and not disparities . We evaluated the extent to which women were satisfied with their decision about participating in genetic counseling for BRCA1/2 mutations and identified variables that were associated significantly with satisfaction . Prospect i ve study of decision satisfaction with 135 African American women who had a minimum 5 % prior probability of having a BRCA1/2 mutation .  Decision satisfaction was evaluated one month after women were offered participation in genetic counseling using a structured question naire . Women were satisfied with their participation decision ; more than 80 % reported that their decision was consistent with their family values . However , women who declined pre-test counseling had significantly lower satisfaction scores . Our findings highlight the importance ensuring that racial differences that are due to preferences and values are not misclassified as disparities in order to identify and address the root causes of disparate treatment BACKGROUND In response to the isolation of the BRCA1 gene , a breast-ovarian cancer-susceptibility gene , biotechnology companies are already marketing genetic tests to health care providers and to the public . Initial studies indicate interest in BRCA1 testing in the general public and in population s at high risk . However , the optimal strategies for educating and counseling individuals have yet to be determined . PURPOSE Our goal was to evaluate the impact of alternate strategies for pretest education and counseling on decision-making regarding BRCA1 testing among women at low to moderate risk who have a family history of breast and /or ovarian cancer . METHODS A r and omized trial design was used to evaluate the effects of education only ( educational approach ) and education plus counseling ( counseling approach ) , as compared with a waiting-list ( control ) condition ( n = 400 for all groups combined ) . The educational approach review ed information about personal risk factors , inheritance of cancer susceptibility , the benefits , limitations , and risks of BRCA1 testing , and cancer screening and prevention options . The counseling approach included this information , as well as a personalized discussion of experiences with cancer in the family and the potential psychological and social impact of testing . Data on knowledge of inherited cancer and BRCA1 test characteristics , perceived risk , perceived benefits , limitations and risks of BRCA1 testing , and testing intentions were collected by use of structured telephone interviews at baseline and at 1-month follow-up . Provision of a blood sample for future testing served as a proxy measure of intention to be tested ( in the education and counseling arms of the study ) . The effects of intervention group on study outcomes were evaluated by use of hierarchical linear regression modeling and logistic regression modeling ( for the blood sample outcome ) . All P values are for two-sided tests . RESULTS The educational and counseling approaches both led to significant increases in knowledge , relative to the control condition ( P < .001 for both ) . The counseling approach , but not the educational approach , was superior to the control condition in producing significant increases in perceived limitations and risks of BRCA1 testing ( P < .01 ) and decreases in perceived benefits ( P < .05 ) . However , neither approach produced changes in intentions to have BRCA1 testing . Prior to and following both education only and education plus counseling , approximately one half of the participants stated that they intended to be tested ; after the session , 52 % provided a blood sample . CONCLUSIONS St and ard educational approaches may be equally effective as exp and ed counseling approaches in enhancing knowledge . Since knowledge is a key aspect of medical decision-making , st and ard education may be adequate in situations where genetic testing must be streamlined . On the other h and , it has been argued that optimal decision-making requires not only knowledge , but also a reasoned evaluation of the positive and negative consequences of alternate decisions . Although the counseling approach is more likely to achieve this goal , it may not diminish interest in testing , even among women at low to moderate risk . Future research should focus on the merits of these alternate approaches for subgroups of individuals with different background s who are being counseled in the variety of setting s where BRCA1 testing is likely to be offered Abstract The authors investigated factors that predict intention to take a genetic test for Alzheimer 's disease ( AD ) . The 449 men and women were surveyed in two groups : ( a ) those told that a positive result meant a 90 % chance of developing AD ( increased certainty ) and ( b ) those told that a positive result meant a 50 % chance of developing AD ( decreased certainty ) . Participants completed measures of the  Theory of Planned Behavior ( TPB ) , anticipated regret , risk perception , likelihood of taking a genetic test for cancer , and AD risk factors .  Just over 50 % of the variance in intentions was related to TPB variables , likelihood of taking a genetic test for cancer , number of people the participants knew who had AD , experimental condition , and anticipated regret . The subjective norm was the strongest predictor of intention in the increased certainty group , whereas positive belief was the strongest predictor in the decreased certainty group 
    Output:
    
Anticipated negative affective responses , such as an inability to “ h and le ” the results of testing , are barriers to uptake .
Specific perceptions , beliefs , and emotional factors are associated with genetic risk assessment among African American women .