Roles of Attitudes and Injunctive Norms in Decisional Conflict and Disclosure Following Receipt of Genome Sequencing Results

Allecia E Reid 1, Rebecca A Ferrer 2, Sanjana Kadirvel 3, Barbara B Biesecker 4, Katie L Lewis 5, Leslie G Biesecker 5, William M P Klein 2

Affiliations

PMID: 32624263
DOI: 10.1016/j.socscimed.2020.113147

Abstract

Rationale: Individuals who choose to obtain genetic information may learn that their genetic profile confers health risks to themselves or offspring. Individuals may react more negatively to this information when personal attitudes, perceived norms, and/or the decision to receive results conflict with one another.

Objective: We predicted that holding more negative attitudes (personal evaluations) or injunctive norms (perceptions of others' approval) toward obtaining genetic test results would prospectively predict greater conflict about the decision to undergo sequencing and less disclosure of sequencing results to family members. We also expected attitudes and norms to interact, such that attitudes would be negatively associated with decisional conflict and positively associated with disclosure when injunctive norms were positive, but weakly associated with outcomes when injunctive norms were negative.

Method: Participants (N=312) were enrolled in a genomic sequencing trial focused on identifying carrier genetic variants, reflecting a variant that might affect their biological children's or grandchildren's health. Participants reported attitudes and injunctive norms, underwent sequencing, and later received results indicating carrier status for at least one variant. Decisional conflict was assessed at immediate post-test, and 1- and 6-month follow-ups. Disclosure of results to children and siblings were assessed at 1 and 6 months.

Results: In structural equation models with covariates, attitudes were negatively associated with post-test and 1-month decisional conflict. Injunctive norms were negatively associated with decisional conflict at 1 and 6 months and positively associated with disclosure to children and siblings at 1 month. The significant attitudes by injunctive norms interaction predicting post-test decisional conflict supported lower decisional conflict when attitudes, norms, and the decision to receive results were all aligned. Exploratory analyses supported indirect effects of attitudes and norms on 6-month sibling disclosure via 1- month decisional conflict.

Conclusion: Results support roles of psychosocial factors in decisional conflict and disclosure after receiving sequencing results.

Keywords: Attitudes; Decisional conflict; Disclosure; Genomic sequencing; Injunctive norms.