Table 3.

Barriers to communicating genetic risk with family members

Major analytic theme	Quote #	Supporting quote
Family culture	1	“Like, the first thing I was kind of annoyed at my extended family for not telling us anything. But we lived in a kind of family who has a culture that you don't tell stuff that's personal. And so, man oh man, it would have been really good to know about that, but that's nothing to do with institutions. That's a family culture problem, the hush‐hush.” (004)
	2	“I don’t communicate with my family”. (024)
	3	“…it's hard because my mom is not living with me, she is back home…So, it's hard to tell them what's really going on. Our culture is different from here…They hear you have cancer…I know I'm going to die, but it's hard for them and it's hard for me”. (001)
	4	“We're very open to talking to one another about everything in our lives, and so when we share something like heredity and DNA, then it just sort of confirms that we are definitely part of a family”. (003)
Communicating with young relatives	5	“I have two sons, grown‐up sons with children of their own. And I told them. It was hard to tell them…I remember myself at their age. Things like that meant nothing to me…” (014)
	6	“I don't know how seriously they take it. You know, even with the melanoma…I'm always going on about sunscreen, and being careful and wearing hats, and… I don't think they pay that much attention or take it that seriously… I find that, you know, that's the thing about young people thinking they're infallible perhaps’. (018)
	7	“The conversation with my brother was… awkward a little bit…I don’t really think he fully understands what it might mean for him down the road if he decides to have children”. (009)
Resistant family members	8	“So I just tried to explain to her that it's good to know, and now you will be able to keep on top of it with screening and so on. So it's good information to have. And the other daughter, of course, feels the opposite. She feels not knowing would be better than having the stress of knowing”. (012)
	9	“She's one of these people that isn't wanting to know too many medical details”. (021)
	10	“I think it scared them when I got cancer because they saw what happened to my mom. So when it came down to the genetics, they didn’t want to think about it. Especially my oldest and she’ll probably never, ever”. (023)
	11	And my brother reacts strongly to all this. When I had the…cancer and I told him, he said, “Oh, they always make mistake. You have nothing”. (014)
	12	“I worry more about my nieces and my nephews. And I don't know what to do. If I should tell them or not…It's like putting a bowling ball in their lives. I don't know how to do it”. (014)
	13	“So my brother's wife was a little resistant. She was like, "If you have it I'm not telling my daughters…I don't want to start freaking them out for the future." But to me that was a poor decision, but I guess that leads to some other moral issues. Do you go behind their backs and tell their daughter…?’ (006)
Familiarity with discussing cancer	14	“She's always known, all along, you know, that this may be passed on, and that we will end up having this discussion”. (017)
	15	“I was in touch with the other [siblings] as I was having the testing done, and I said, "This could ‐‐ you know, you could possibly ‐‐ if this test comes back positive, there is an option that you guys could be tested and see if it stops here." And they were all onboard with that. None of them didn't want to know. They all wanted to know so that they could take possible actions to stop it. And two of my siblings have female offspring, and they're worried about them having the breast cancer factors. And so they're going through the testing right now. And I was informed that if it's negative for them, then it doesn't go past that generation”. (002)
	16	“That's maybe one of the sad parts, when there's enough people in the family that have had cancer that ‐‐ I guess they sort of accept it as a reality that, you know, the likelihood of people getting cancer is quite high. So they're sort of familiar with the process”. (015)
	17	It was a little challenging initially just telling my parents, because both of them didn’t want it to be from them. So, there was a bit of tension. And a little bit of guilt from both of them, and that was really tough. 009