Coping response and family communication of cancer risk in men harboring aBRCAmutation: A mixed methods study

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Abstract
Objective: Providing genetic counseling and genetic testing to at‐risk blood relatives (cascade screening) is important for improvingBRCAcancer outcomes. Intra‐familial communication of risk is critical for cascade screening efforts yet relatively little is known about men's role in communicatingBRCArisk. We sought to examine men's coping response to theirBRCAstatus and intra‐familial communication of risk to inform the development of tailored interventions that could promote cascade screening.Methods: We employed a sequential mixed‐methods design. First, we measured coping response (quantitative) using the Multidimensional Impact of Cancer Risk Assessment (MICRA). MICRA scores were compared betweenBRCA+ men,BRCA− men andBRCA+ women. Subsequently, we used template analysis to analyze qualitative interviews exploring coping and intra‐familial communication of risk. The Theory of Planned Behavior (TPB) served as a guiding framework for identifying intervention targets.Results: BRCA+ men (n = 36) had significantly higher levels of distress (p < 0.001), uncertainty (p < 0.001) and negative experiences (p < 0.05) compared toBRCA− male counterparts (n = 23).BRCA+ men had significantly lower distress (p < 0.001) and uncertainty (p < 0.001) thanBRCA+ women (n = 406). Qualitative analysis of in‐depth interviews withBRCA+ men (n = 35) identified promoters and barriers to active coping response and intra‐familial communication of risk. Mapping results onto the TPB identified targets for tailoring person‐centered approaches for men addressing beliefs/attitude, subjective norms, and perceived behavioral control.Conclusions: Men and women appear to have different coping responses to learning theirBRCAstatus. Developing tailored (sex‐based), theory informed interventions may help promote intra‐familial communication ofBRCArisk and support cascade screening.

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