Interventions to Improve Patient Education Regarding Multifactorial Genetic Conditions: A Systematic Review

The sequencing of the human genome will impact the delivery of health care in significant way. One of these is the increase of genetic information and diagnoses for patients. The understanding of multifactorial disorders will increase, and patients may be able to know if they are at risk for multifactorial genetic conditions, which involve several genes and possibly environmental factors. This systematic literature review of experimental trials of various interventions for patient education regarding genetic information for multifactorial disorders attempts to elucidate the answer to the question: is there sufficient evidence for best practice for delivering genetic information to patients? Various interventions (computer/ CD rom, group counseling, video/decision aid, and miscellaneous) are analyzed in terms of quality criteria and achievement of specific outcomes and rated according to the Stetler model for evidence based practice. Seven main outcomes were evaluated: 1.objective and subjective knowledge assessment 2.psychological measures (general anxiety, depression, stress, cancer worry) 3.satisfaction/effectiveness of intervention 4.time spent in counseling (time spent on basic genetic information vs. specific concerns) 5.decision making/intent to undergo genetic testing 6.treatment choice and value of that choice, and, finally 7.risk perception. Findings were compared based on whether or not interventions achieved statistically significant changes in outcomes. Overall, the computer interventions resulted in more statistically significant findings that were beneficial than any other category, followed by the video category, although the group and miscellaneous categories did not measure all of the outcomes reported by the other two categories. Nevertheless, while these groups had neutral or negative findings in some of the outcomes, the computer intervention group showed statistically significant improvement in genetics knowledge, psychological measures, satisfaction/effectiveness, time spent with counselor, and decision/intent to undergo testing.

Learning Objective #1: ...appreciate different interventions which have been researched for the communication of genetic information to patients at risk for conditions involving more than one gene.
Learning Objective #2: ...compare the statistical significance of these various interventions in regard to outcomes such as knowledge gain/retention, anxiety, depression, risk perception, satisfaction with visit, etc.