Table 1 Intervention elements

Step 1

Agenda setting

Introducing the subject of family communication about hereditary or familial cancer risks and preventive measures. Explicitly ask the counselee if he/she is willing to discuss this issue.

Step 2

Exploring

Systematically exploring counselees’ current and planned pattern of informing relatives. Psychosocial workers investigate whether the counselee correctly knows which family members are at risk and which information should be provided to them.

Evaluation

After the first phase the psychosocial worker verifies whether or not all at-risk relatives are informed thoroughly (thoroughly = at least the written advice in the summary letter). If the counselee has informed all at-risk relatives properly the psychosocial worker will end the counseling session. If not, the psychosocial worker will start phase 2.

Phase 2: additional information and brainstorming

Step 3

Additional information

Additional or corrective information is provided, if needed. For example, in case of BRCA 1/2 it is important to stress that male relatives can also transmit the risk and thus need to be informed.

Step 4

Building motivation

The purpose of the fourth phase is to build motivation and strengthen self-efficacy. Psychosocial workers invite counselees to verbalize arguments in favor of informing relatives, to reinforce these arguments and thus strengthen the counselees’ motivation. Any barriers are also assessed and discussed. These barriers can be practical, for example, not having personal contact, and/or emotional, for example, causing too much distress. Also, reasons for (non)disclosure are explored, so as to understand the counselee’s perspective and motives, to build rapport and reduce resistance. Likewise, the counselees’ confidence in their ability to correctly and sufficiently inform relatives is assessed and strengthened.

Step 5

Brainstorming

During the final phase, the psychosocial worker invites the counselee to engage in active brainstorming on possible solutions for informing more difficult to approach relatives. The goal is to develop a plan for informing these relatives.