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Open Access Open Badges Research article

Effects of a pre-visit educational website on information recall and needs fulfilment in breast cancer genetic counselling, a randomized controlled trial

Akke Albada1*, Sandra van Dulmen12, Jozien M Bensing13 and Margreet GEM Ausems4

Author Affiliations

1 NIVEL (Netherlands Institute for Health Services Research), Otterstraat 118-124, Utrecht, 3500 BN, the Netherlands

2 Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Geert Grooteplein-Noord 21, Nijmegen, 6525 EZ, the Netherlands

3 Department of Psychology, Utrecht University, Heidelberglaan 1, Utrecht, 3584 CS, the Netherlands

4 Department of Medical Genetics, University Medical Center Utrecht, Lundlaan 6, 3508 AB, the Netherlands

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Breast Cancer Research 2012, 14:R37  doi:10.1186/bcr3133


Published: 6 March 2012



Pre-visit education which helps counselees to prepare for their first visit for breast cancer genetic counseling might enhance information recall and needs fulfilment. This study assessed the effects of a pre-visit website with tailored information and question prompt sheet (QPS), named E-info geneca.


A total of 197 counselees were randomized to receive usual care (UC) or UC plus E-info geneca. All counselees completed a pre- and post-visit questionnaire and visits were videotaped. We studied effects on counselees' information recall, knowledge about breast cancer and heredity, fulfillment of needs, risk perception alignment, anxiety and perceived personal control, using multilevel regression analyses.


Intent-to-treat analysis showed that counselees in the intervention group (n = 103) had higher levels of recall of information from the consultation (β = .32; confidence interval (CI): .04 to .60; P = .02; d = .17) and post-visit knowledge of breast cancer and heredity (β = .30; CI: .03 to .57; P = .03) than counselees in the UC group (n = 94). Also, intervention group counselees reported better fulfilment of information needs (β = .31; CI: .03 to .60; P = .03). The effects of the intervention were strongest for those counselees who did not receive an indication for DNA testing. Their recall scores showed a larger increase (β = .95; CI: .32 to 1.59; P = .003; d = .30) and their anxiety levels dropped more in the intervention compared to the UC group (β = -.60; CI: -1.12 to -.09; P = .02). No intervention effects were found after the first visit on risk perception alignment or perceived personal control.


This study shows that pre-counseling education, using tailored information technology, leads to more effective first visits for breast cancer genetic counseling, in particular for counselees who received no indication for DNA testing and, therefore, had no indication for a second visit. Future study should focus on the effects of a pre-visit website on the outcomes after a complete series of visits.

Trial registration

Dutch Trial Register ISRCTN82643064.