Table 2.

Overview of Tailored Counseling and Navigation Arm

Step 1: Introduction and Rapport Building.

Step 2: Address HBOC Threat Perceptions. To enhance HBOC risk perception, the health coach elicits the women’s awareness and thoughts about the CGRA referral guidelines. The coach provides information about the participant’s personal risk for a HBOC-related second cancer, and acknowledges that male and female blood relatives maybe at increased cancer risk. Participant responses are used to enhance cognitive processing of information.

Step 3: Address Barriers and Efficacy. The coach elicits the participant’s response efficacy beliefs, including risk management options for HBOC. If desired by the participant, the health coach describes the CGRA/genetic counseling process; its effectiveness in helping women like them and their blood relatives; and addresses questions, concerns or misconceptions about CGRA. The coach uses the “Importance” Ruler (1 - 10 scale) to elicit participant talk around desire and reasons for CGRA. The coach uses the “Readiness” Ruler (1 - 10 scale) to elicit participant talk around ability, confidence, and commitment to obtain CGRA within the next six months. Throughout the interaction, the health coach utilizes open-ended questions to elicit and reinforce the participant’s reasons for undergoing CGRA. The coach explores factors that the participant believes would increase priority and/or efficacy to get a CGRA. The coach also elicits and attempts to resolve the participant’s two most important barriers to getting CGRA.

Step 4: Construct an Action Plan. Using the readiness ruler and action planning visual aids, the coach prompts the participant to create a personalized action plan. The health coach applies implementation intention principles by encouraging the participant to formulate a plan (or a hypothetical plan if she is not ready or willing to make an actual plan) to obtain a CGRA.

Step 5: Provide Navigation as Needed. The coach offers assistance (navigation) to help the patient overcome barriers and asks permission to follow-up with them to provide further help as needed. For example, coaches may help participants find a genetic provider, access health insurance, help participants determine if their insurance covers genetic counseling/testing, assist with making the appointment, and assist with arranging transportation. The dose and follow-up navigation activities (patient interaction time and additional coach time) are tracked and analyzed as process variables.

Step 6: Summary, Closing and Follow-up. The coach provides a summary of the participant’s primary reasons for getting CGRA, how they will address the top two barriers (if any barriers are identified) as well as the action plan. The coach asks permission to send a letter to the patient’s primary provider letting them know that the participant meets the referral criteria for CGRA according to national guidelines and a copy of the participant’s tailored letter. For participants who identify barriers, the coach delineates the next steps (navigation strategy as needed), and schedules a time for a follow-up call with the patient. A tailored letter is mailed immediately after the phone session that includes the women’s personalized action plan. Women receive a follow-up call from the health coach 7 weeks after the telephone call to assess need for additional navigation and provide assistance. The number, dose (i.e., time) and nature of the navigation assistance are tracked and evaluated in the cost analysis.