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Conference Recap: Coping with Risk and Family Dynamics

by Drea Thew

Presented at the 2006 Joining FORCEs Conference by Paul B. Jacobsen PhD, Program Leader, Psychosocial and Palliative Care Program, Moffitt Cancer Center

Dr. Jacobsen, a clinical psychologist who specializes in psychosocial oncology, discussed the emotional, psychological and family concerns that arise from genetic testing.

Even before testing, the act of gathering family history or requesting that relatives be tested can generate conflict within a family. After testing, informing family members of the results can be very difficult in light of prior family estrangement—as in Dr. Jacobsen’s example, “I haven’t spoken to my cousins in 25 years. Now I’m going to call them out of the blue to say they may have a genetic mutation that increases risk for breast and ovarian cancer?”

Conflict can also arise when the information is perceived as upsetting or useless (particularly in male relatives). Dr. Jacobsen suggests providing information in a neutral way that allows relatives to make their own choices (“I was tested and I have my results, are you interested?”), rather than in a directive way (“I have this mutation—you and your daughters need to get tested too”). When there is pre-existing family conflict, he recommends involving a neutral third party (such as a mental health professional) to help facilitate productive communication.

Dr. Jacobsen discussed why people might get “stuck” in choosing a risk management strategy. When an individual receives conflicting information from doctors, it can lead to mistrust of the information. Feeling there is always more information to acquire, that a new option is right around the corner, or that there is a “wrong” choice, may keep individuals from making a decision. Discord with a spouse or other loved ones about the right decision can cause confusion.

Dr. Jacobsen discussed “problem-solving therapy” as a strategy to help individuals get “unstuck” and move forward. This results-oriented therapy focuses on four steps:

  1. Problem definition and formulation
  2. Generation of alternatives
  3. Decision-making
  4. Solution implementation and verification

Drea Thew is a FORCE Helpline volunteer.

Coping: Additional Reading

B. Meiser, Psychological Impact of Genetic Testing for Cancer Susceptibility: An Update of the Literature. Psychooncology, December 2005; 14(12):1060-74.

Testing for Cancer: Psychological Approaches for Helping Patients and Families by Andrea Patenaude (American Psychological Association, 2004).

Helping Cancer Patients Cope: A Problem-Solving Approach by Arthur Nezu, Ph.D. (American Psychological Association, 1998).

Conference Webcast

View a free webcast of the audio and PowerPoint slides from our 2006 Joining FORCEs conference.

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