Table 2.

Therapeutic interventions related to the gears of anticipatory loss in hereditary cancer

Intervention component	Therapeutic goals	Lead provider(s)
Psychoeducation: educational support	Define and distinguish primary, secondary, and anticipatory loss from other forms of grief	Mental health provider Genetics provider(s)
	Revisit LFS-related cancer risk estimates
	Outline procedural steps from cancer screening to diagnosis and treatment
	Practice hard conversations
	Teach and practice tools for coping and stress-reduction
	Introduce conversations about family histories and rehearsals of loss
	Assess family communication for immediate and long-term coping and intervention
Psychoeducation: emotional support	Scaffold meaning-making for bereavement	Mental health provider
	Process anticipatory reactions
	Reconcile family histories and risk estimates with fatalistic thoughts
	Introduce ways to maintain hope
	Discuss challenging decisions
Family interventions	Identify ways family histories inform anticipation about illness and loss	Mental health provider
	Identify ways families rehearse or prepare for primary and secondary losses
	Distinguish the nature and impact of secondary losses for individuals versus family groups
	Support flexibility in family roles to meet pragmatic, emotional, financial needs of patients and caregivers
	Support family communication to facilitate coping with anticipatory loss