Counseling for familial breast cancer focuses on communicating the gene test result (GENE) to counselees, but risk prediction models have become more complex by including non-genetic risk factors ... Show moreCounseling for familial breast cancer focuses on communicating the gene test result (GENE) to counselees, but risk prediction models have become more complex by including non-genetic risk factors (NGRF) and polygenic risk scores (PRS). We examined genetic clinicians' confidence in counseling and counselees' psychosocial outcomes, using the BOADICEA risk prediction tool with different categories of risk factors as input. A prospective observational study in Dutch, French and German genetic clinics was performed including 22 clinicians, and 406 of 460 (88.3%) eligible cancer-unaffected women at high breast cancer risk assessed at pre-test and 350 (76.1%) at post-test. We performed multilevel analyses accounting for the clinician, and counselees' characteristics. Overall, risk estimates category by GENE versus GENE+ NGRF, or GENE+NGRF+PRS differed in 11% and 25% of counselees, respectively. In multilevel analyses, clinicians felt less confident in counseling when the full model provided lower breast cancer risks than GENE (i.e., in 8% of cases). Older counselees expressed higher breast cancer risk perception and worries about the hereditary predisposition when the full model provided higher breast cancer risks than GENE only. Genetic clinicians appear confident with breast cancer risk comprehensive models, which seem only to affect perceptions of older counselees. Show less
Little is known about the effects of different instructional approaches on learner affect in oral interaction in the foreign language classroom. In a randomized experiment with Dutch pre‐vocational... Show moreLittle is known about the effects of different instructional approaches on learner affect in oral interaction in the foreign language classroom. In a randomized experiment with Dutch pre‐vocational learners (N = 147), we evaluated the effects of 3 newly developed instructional programs for English as a foreign language (EFL). These programs differed in instructional focus (form‐focused vs. interaction strategies‐oriented) and type of task (pre‐scripted language tasks vs. information gap tasks). Multilevel analyses revealed that learners’ enjoyment of EFL oral interaction was not affected by instruction, that willingness to communicate (WTC) decreased over time, and that self‐confidence was positively affected by combining information gap tasks with interactional strategies instruction. In addition, regression analyses revealed that development in learners’ WTC and enjoyment did not have predictive value for achievement in EFL oral interaction, but that development in self‐confidence did explain achievement in EFL oral interaction in trained interactional contexts. Show less
