Psychosocial Support

Just as important as a careful risk factor analysis and interpretation of risk to family members is attention to the psychosocial issues raised by the enhanced risk and the emotional needs of those involved.27 This consideration is especially critical in the setting of counseling for cancer risk, which deals with the complexity of probabilities, which involves the entire family, and which may provide risk information that can become a source of discrimination. Cancer is one of the most feared diseases of modern times. Cultural beliefs about cancer, painful memories of relatives' experiences with cancer, high levels of mental stress associated with cancer-related anxiety, unresolved grief, feelings of denial, guilt, and other family dynamics can all interfere with the receipt and understanding of risk information and with the formulation of strategies for risk reduction and can have a negative impact on quality of life. Both the information received during the process of genetic counseling and the information-seeking coping style of the individual may elicit further emotional reactions, especially if the counseling involves the receipt of genetic test results. The counselor takes an active role in helping the counselee identify his/her risk status, confront fears and anxieties about the meaning of that risk, develop coping strategies to deal with both the emotional and medical components of his/her unique situation and coping style, and facilitate decision making. The counselor can also assist the counselee in communicating cancer risk information to other family members, in dealing with their potential reactions, and in enrolling them in a counseling program. Follow-up genetic counseling sessions have been found to reinforce the information communicated in the original sessions, to solidify decisions made, to assess adjustment to risk status, and to make referrals for specialty consultations if needed.28

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