Family communication following genetic counselling for breast/ovarian cancer
Green JM., Richards MPM., Murton FE., Statham H., Hallowell N.
An appointment at a family cancer clinic is likely to stimulate family communication. Before the clinic, family members are likely to be contacted by the proband to establish the family tree and details of deaths and diagnoses. At the consultation itself, other family members will be discussed. They may even be present. After the clinic further communication takes place as the information obtained is fed back to others to whom it may be relevant. Twenty-nine women attending a Cancer Family History Clinic were interviewed in depth approximately 8 weeks after counselling. They had all, by then, received a letter from the counsellor summarising the information given. Almost all had shown the letter to at least one relative. Many expressed the view that they had a duty to pass on information, especially to daughters and nieces. However, the perception of a duty to inform was heavily tempered by a concern not to upset, and information was frequently not offered to those who were judged currently to have other problems to deal with, such as illness or divorce. Information was most likely to be passed on when it could be integrated into communication that would be taking place in any case. This is most likely where family members meet face to face. Passing information to male relatives was often seen as particularly difficult, and not all probands understood why the information might be relevant. Family Cancer Clinics aim to provide information which will allow people to make choices and to give access to appropriate services. To what extent does this aim extend to other family members beyond the proband? All genetic counselling is likely to have effects on other family members whether the counsellor intends this or not. Counsellors need to consider what information they would like to be received and by whom, and to have a strategy for facilitating this.