Communication in the Family

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The effect of risk communication is also reflected in subsequent disclosure of risk information in the family (Hopwood 2005). There is a need to improve knowledge about communication strategies within the family and their impact on family relationships and family members' reactions. Very few studies have been conducted in this field.

Tercyak and coworkers (2001) evaluated the psychological impact of the parental communication of the result of BRCA1/2 testing. Mothers (versus fathers) and subjects with the highest levels of general emotional distress more easily informed their children about the test results. Coping strategies after the test (both active and avoidant) were positively correlated with the post-counselling distress level. However, communication of the result to the children did not modify the counselee's level of distress, but increased their children's level of distress.

The same authors also evaluated the parent-child relationship and its impact on the communication of test results to the children (Tercyak et al. 2002). Older children appeared to be more frequently informed about the test results, and the communication style within the family seemed to predict the way mothers shared the information with their children (the test result was more frequently shared when the communication style between parents and children was more open), and was not modified by revelation of the result.

Blandy and coworkers (2003) showed that results of BRCA tests were generally adequately transmitted to the family; difficulties of transmission, however, correlated with a poorer understanding and a higher level of anxiety and avoidance. First-degree relatives were most frequently informed about the test results, but they only rarely requested genetic testing, which was essentially requested by sisters and daughters. The quality of family support and the level of understanding of the risk of transmission were positively and significantly correlated with the decision to perform the test in first-degree relatives.

In France, the bioethical legislation has recently considered this medical situation in which information elicited in one individual of a family concerns all its members. The latest bioethical law sets that the biomedical agency takes the responsibility to confer this information to the different family members: the transmission should proceed from doctor to doctor, and from them to family members (Public Health Policy, Biomedi-cine Agency, 2004).

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