Genetic nurse counsellors can be an acceptable and cost-effective alternative to clinical geneticists for breast cancer risk genetic counselling: Evidence from two parallel randomised controlled equivalence trials

Nicola Torrance, Jill Ann Mollison, Sarah Wordsworth, Jonathon Gray, Zofia Helena Miedzybrodzka, Neva Elizabeth Haites, Adrian Grant, Marion Kay Campbell, M.s. Watson, Angus Clarke, Brenda Wilson

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This study compared genetic nurse counsellors with standard services for breast cancer genetic risk counselling services in two regional genetics centres, in Grampian region, North East Scotland and in Cardiff, Wales. Women referred for genetic counselling were randomised to an initial genetic counselling appointment with either a genetic nurse counsellor (intervention) or a clinical geneticist (current service, control). Participants completed postal questionnaires before, immediately after the counselling episode and 6 months later to assess anxiety, general health status, perceived risk and satisfaction. A parallel economic evaluation explored factors influencing cost-effectiveness. The two concurrent randomised controlled equivalence trials were conducted and analysed separately. In the Grampian trial, 289 patients (193 intervention, 96 control) and in the Wales trial 297 patients (197 intervention and 100 control) returned a baseline questionnaire and attended their appointment. Analysis suggested at least likely equivalence in anxiety (the primary outcome) between the two arms of the trials. The cost per counselling episode was 11.54 UK pounds less for nurse-based care in the Grampian trial and 12.50 UK pounds more for nurse-based care in Cardiff. The costs were sensitive to the grade of doctor (notionally) replaced and the extent of consultant supervision required by the nurse. In conclusion, care based on genetic nurse counsellors was not significantly different from conventional cancer genetic services in both trial locations.
Original languageEnglish
Pages (from-to)435-444
Number of pages10
JournalBritish Journal of Cancer
Issue number4
Publication statusPublished - 2006



  • Adolescent
  • Adult
  • Anxiety
  • Breast Neoplasms
  • Cost-Benefit Analysis
  • Female
  • Genetic Counseling
  • Health Status
  • Humans
  • Nurses
  • Patient Education as Topic
  • Patient Satisfaction
  • Risk

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