Providing Psychosocial Support to Hereditary Cancer Risk Patients
Thursday, 20 September 2007 - 1:30 - 5:00 pm
presented by Karen Hurley PhD

Target Audience: Health care professionals who provide psychosocial services (psychologists, psychiatrists, social workers, genetic counselors, advanced-practice nurses) and others with an interest in the psychosocial aspects of hereditary cancer risk

Workshop Objectives:

1. To identify psychosocial issues that are particularly germane to hereditary cancer risk patients within the larger population of psycho-oncology patients.

2. To learn specific assessment and intervention techniques to use with hereditary cancer risk patients during consultations and psychotherapy.

Workshop Description:

Individuals with inherited susceptibility for cancer face a number of unique challenges relative to other psycho-oncology patients, including (but not limited to): high risk of second tumors at the same or other sites, multiple risk management decisions beyond the current illness, multiple experiences of illness and loss within the family, and intensive engagement with the healthcare system for surveillance and risk reduction even if they never have had cancer.

This half-day workshop will combine didactics, case histories, role play, and discussion to review methods for providing psychosocial support to hereditary cancer risk patients. The workshop will consist of four sections: 1) overview of hereditary cancer syndromes; 2) four mini-modules based on common presenting issues; 3) summary of relevant theory and techniques for assessment and treatment; 4) role-play and discussion of case material.

In the overview, we will review basic information about common hereditary syndromes, the genetic counseling process, risk management recommendations, psychological challenges of hereditary cancer, and typical reasons cancer genetics patients are referred for additional psychosocial support.

In the mini-module section, we will focus on four common presenting issues:

Distress: Although most individuals undergoing genetic testing for cancer risk do not become distressed, approximately 15–25% show elevated levels of distress, most notably intrusive ideation about cancer risk. We will discuss brief methods for screening for distress, and therapeutic approaches to intrusive ideation about cancer risk.

Bereavement and illness in the family: We will discuss: the impact of multiple experiences of illness and death in the family on individual development and adjustment, lay health beliefs resulting from these experiences and their impact on risk perceptions, the concept of the “parentified child”, and implications of bereavement for risk management decisions.

Decision-making about risk-reducing surgery: We will discuss hallmarks of fully informed decision-making about prophylactic surgery, and present an 8-domain structured consultation we use in clinic to assist patients with their decisions, and to assess readiness for surgery.

Family communication: We will discuss: when and how to tell adult and minor children about risk, ethical issues in informing at-risk relatives, and balancing between individual and family needs in dealing with risk.

In the summary section, we will discuss the interplay of three different psychotherapeutic approaches – psychodynamic, cognitive-behavioral and existential - and how each informs psychosocial care of hereditary risk patients. We will also review specific techniques to address immediate concerns identified during consultation (e.g., decisions about risk management or preparation for surgery). These techniques include coping statements, brief role play, expressive writing, relaxation training, and activation of social support.

In the experiential section, participants will be encouraged to present case examples for group discussion. The facilitator will also have prepared cases to distribute, as well as role play exercises.