Table 3.

Summary of post-test counseling session protocol

Post-test result disclosure education	• Provide test results and associated risk estimates.
	• For mutation carriers, review age-specific penetrance of hereditary breast and ovarian cancer.
	• Review probability of breast and ovarian cancers in the general population.
	• Provide verbal and written information about options for surveillance and recommendations for preventive measures based on BRCA status.
	• For those who do not have a primary care provider (or regular source of health care) or have not recently had cancer screening (depending on age and genetic status) provide referral information (appropriate for socioeconomic status and health insurance status) for cancer screening and risk reduction services.
	• Explain altered risks in relatives; make recommendations that adult high-risk relatives be informed of the availability of risk information and genetic counseling.
	• For mutation carriers, review inheritance pattern of BRCA1/2 mutations and identify at-risk relatives (including future children when appropriate).
	• Mail tailored letter to patient (and their health care provider if they desire) that includes personalized recommendations for the patient and their family members based on their test result.
Post-test result disclosure counseling	• Explore participants’ emotions and concerns.
	• Make referrals to appropriate physicians, mental health providers and other professionals as requested by the patient or as needed. At the conclusion of the session, the genetic counselor will: 1) explain that she/he is available for questions and to help address concerns by telephone for the duration of the study if needed, and 2) send a results/counseling letter that includes recommendations for surveillance/prevention to the participant’s primary provider if they desire. This is standard genetic counseling practice.
	• Explore participants’ preferences regarding cancer screening and risk reduction options based on genetic test result.
	• Provide test results and risk education in a supportive manner.
	• Assess risk perceptions with regard to their test result and correct misconceptions.
	• Explore intentions to communicate test results to at-risk and other family members and discuss concerns and issues.
	• Answer questions.
	• Assess and discuss additional concerns or issues expressed by the participant.
	Provisions for follow-up
	• Make follow-up/referral arrangements.
	• Instruct participants to contact counselor if they encounter barriers to accessing services.
	• Send BRCA test results/counseling letter that includes recommendations for surveillance/ prevention to the patients’ preferred primary care provider if they desire.