Of Cancer Genetic Counselling

Studies indicate that cancer genetic consultants present generally good practice in terms of the information they provide; however, they less frequently demonstrate attention or skills to deal with the subjective aspects of the genetic counselling, i.e. verifying the counselee's understanding of the information, assessing emotional reactions or attitudes of informed family members.

Biesecker and Peters (2001) proposed a working definition for genetic counselling consultations that defines the goals as "promoting understanding, achieving informed consent, fa-

cilitating decision-making, reducing psychological distress, restoring feelings of personal control and advancing adaptation to stress-inducing events".

These objectives are much more exhaustive than those regarding patient information. However, this definition raises new questions: What is the exact role of the geneticist or genetic counsellor, especially concerning the evaluation of emotional reactions or the provision of psychosocial support?

There is a growing number of guidelines for communicating risk, suggesting the need to develop and evaluate innovative communication strategies (Bottorff et al. 1998; Hopwood 2005). Genetic counsellors should also be encouraged to explore idiosyncratic risk beliefs, personal theories of inheritance, and personal or social support that underpin coping. Integration of risk information may be enhanced when emotional issues are addressed. Geneticists or genetic counsellors are confronted with the challenging task of providing objective information which is adapted to the individual, taking into account the individual's concerns and preferences. Coun-selees often express a marked need to receive more attention and information with regard to the possible impact of cancer genetic risk on their daily life and the availability of psychosocial support (Bleiker et al. 1997). These aspects do not seem to be sufficiently addressed in genetic consultations. Several key elements can improve communication.

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