Maternal Communication of BRCA Risk to Adolescent and Young Adult Children: Implications for Supportive Care...

High-risk mothers undergoing BRCA testing must decide whether, when, and how to disclose hereditary cancer risk information to their adolescent and young adult (AYA) children.

This study explored maternal preferences/values and cognitive-affective factors influencing these decisions during genetic counseling.

Mothers (N = 282) reported on the perceived risks/benefits of AYA disclosure. Multivariable regression identified predictors of disclosure, and paired t-tests evaluated changes over time in maternal-AYA communication, distress, and decisional conflict following genetic counseling.

Mothers reported valuing the benefits of disclosure more than risks (p < 0.001). Those who valued disclosure tended to have female (t = -1.74, p = 0.08) and older (r = 0.14, p = 0.03) children but were less knowledgeable about cancer risk (r = -0.17, p = 0.005). Conversely, mothers who perceived disclosure to AYAs as riskier tended to be non-white (t = 1.80, p = 0.072), Hispanic (t = 1.66, p = 0.098), lower-income (t = 2.56, p = 0.011), and with younger children (r = -0.28, p < 0.001) in poorer mental health (r = 0.12, p = 0.047). These findings were reaffirmed though a multivariable regression model controlling for benefits (adjusted R² = 0.11; age B = -1.09, p < 0.001; mental health B = 0.36, p = 0.04). Post-counseling, participants showed reduced decisional conflict (t = 2.4, p = 0.009) but increased depression/anxiety (t = -1.4, p = 0.08) and lower parent-child relationship quality (t = 2.7, p < 0.001).

Clinicians should be attuned to the factors shaping parental disclosure decisions and consider offering additional support to manage distress. Tailored educational tools for parents may aid family communication and improve psychosocial outcomes alongside genetic counseling.