title: Risk communication in completed series of breast cancer genetic counseling visits.
abstract: OBJECTIVE
  There is no consensus on how best to communicate risk in breast cancer genetic counseling. We studied risk communication in completed series of counseling visits and assessed associations with counselees' postcounseling risk perception and satisfaction.
  
  
  METHODS
  Pre- and postcounseling questionnaires and videorecordings of all visits were available for 51 affected and unaffected women from families with no known BRCA1/2 mutation, who fulfilled criteria for DNA testing. We developed a checklist for assessing risk communication and counselors' behaviors.
  
  
  RESULTS
  General risks were mainly communicated in initial visits, while counselee-specific risks were discussed mainly in concluding visits. The risks discussed most often were conveyed only numerically or qualitatively, and most were only stated positively or negatively. Counselors regularly helped counselees to understand the information, but seldom built on counselees' pre-existing perspective. Counselees' breast cancer risk perception after counseling was unrelated to whether this risk had been explicitly stated. The number of general risks discussed was negatively associated with counselees' satisfaction about counseling.
  
  
  CONCLUSIONS
  Findings suggest that counselors' authority prevails over mutuality with individual counselees, in their communication about risks.
authors.affiliation: NIVEL (Netherlands Institute for Health Services Research), the Netherlands.
authors.forename: Arwen H
authors.initials: AH
authors.lastname: Pieterse
authors.forename: Sandra
authors.initials: S
authors.lastname: van Dulmen
authors.forename: Sandra
authors.initials: S
authors.lastname: van Dijk
authors.forename: Jozien M
authors.initials: JM
authors.lastname: Bensing
authors.forename: Margreet G E M
authors.initials: MG
authors.lastname: Ausems
mesh_terms: D000293:Adolescent; D000328:Adult; D001943:Breast Neoplasms / Q000523:psychology*; D002277:Carcinoma / Q000523:psychology*; D003142:Communication; D032882:Comprehension; D005260:Female; D005817:Genetic Counseling / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010465:Perception; D010549:Personal Satisfaction; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012306:Risk; D011795:Surveys and Questionnaires; D000078329:Workforce