Table 2.

Summary of pretest counseling session protocol

Pretest education	• Review the study protocol and answer any questions about the study.
	• Assess baseline knowledge about hereditary breast and ovarian cancer, personal and familial cancer risk, BRCA testing, and reason for participating in genetic education and counseling through this study.
	• Discuss breast and ovarian cancer epidemiology.
	• Discuss inheritance of cancer and cancer risks associated with BRCA mutations.
	• Provide risk assessment for BRCA mutations and discuss availability of BRCA testing.
	• Discuss benefits of genetic testing, including potential for early detection and prevention, and reduction of uncertainty.
	• Discuss limitations of genetic testing, including incomplete penetrance, meaning of indeterminate/inconclusive test results, and etiologic uncertainty.
	• Discuss state/federal protections related to genetic discrimination.
	• Discuss the implications of potential test results and family history for other family members.
	• Provide assurance of confidentiality of test results and related information.
	• Discuss options for cancer screening and risk management and their limitations (whether or not genetic testing is pursued).
	• Answer questions.
Pretest counseling	• The counseling part of the intervention was individualized and tailored to the participant’s personal/family history of cancer and expressed interests/concerns about cancer and/or genetic testing.
	• Explore the psychosocial implications of genetic testing, anticipated reactions to a positive and negative test result, and their intentions to communicate results to family members as well as related interpersonal issues.
	• Explore participants’ perceptions about BRCA testing and risk reduction options with regard to knowledge, values, preferences, expectations of outcomes, and risk reduction options for breast and ovarian cancer.
	• Assess risk perceptions and correct misconceptions.
	• Address any barriers to genetic testing or accessing appropriate cancer screening/risk reduction services the patient endorses.
	• Assess and discuss additional concerns or issues expressed by the participant.
	• For those who are socioeconomically disadvantaged and underinsured or uninsured, assist the patient in obtaining testing through the Myriad financial assistance program.
	• Instruct woman to call the counselor if they encounter access barriers (eg, financial) to testing or desired health services (screening and surgery).
	• Provide additional assistance in accessing services and make referrals as needed.
	• Answer questions.
	• Follow-up: For participants who wish to pursue testing, complete testing paperwork and provide the necessary documentation to help ensure insurance reimbursement for testing. For those who did not wish to pursue genetic testing, or were unsure, send a summary letter of the genetic counseling session. If they desire, send their preferred health care provider a copy of this letter.