The moderating role of parental cognitive perceptions in the link between children's cancer predisposition genetic testing results and parent psychological adjustment.

Objective: Children with cancer increasingly undergo germline genetic testing to identify genetic predispositions and inform clinical care options. Parents of children with pathogenic/likely pathogenic (P/LP) germline results have reported more distress than parents of children with negative results. Little is known about modifiable risk and resilience factors for intervention, such as cognitive perceptions. This study examined the moderating effects of parents' cognitive perceptions on adjustment to their child's germline genetic test results.

Methods: Parents (N = 191) completed surveys reporting cognitive perceptions (i.e., intolerance of uncertainty, symptom attributions, and perceptions of child physical vulnerability) and psychological adjustment 1-3.99 years post-disclosure of their child's genetic test results. Moderation analyses examined whether parents' cognitive perceptions moderated the relation between children's cancer predisposition genetic testing results (P/LP, uncertain [VUS], or negative) and parental psychological adjustment.

Results: Moderation analyses revealed significant interactions between genetic test results and both intolerance of uncertainty and psychological attributions for children's symptoms. Specifically, parents of children with P/LP results endorsed significantly more distress and uncertainty compared to each VUS and negative results, only in cases of moderate to high intolerance of uncertainty and psychological attributions (distress outcomes). In contrast, somatic attributions for symptoms and perceived child vulnerability were directly associated with higher distress regardless of results.

Conclusions: Cognitions such as intolerance of uncertainty and psychological symptom attribution may contribute to distress among parents of children with P/LP results. Therefore, cognitive interventions (e.g., Cognitive Behavioral Therapy, Acceptance and Commitment Therapy) may help parents manage distress regarding their child's genetic cancer risk.