Predictive testing for hereditary breast and ovarian cancer: a psychological framework for pre-test counselling

Since the identification of two breast-ovarian cancer susceptibility genes (BRCA 1/2), predictive testing for hereditary breast/ovarian cancer (HBOC) has been available. Given the complexity and uncertainties of HBOC and the potential impact of predictive testing on psychological well-being, we offe r the test applicants a combination of information-oriented and psychologic al counselling. In this paper, we describe the multidisciplinary approach f or predictive testing for HBOC as a clinical service in Leuven, hereby focu sing on psychological and decision counselling practice. Attention is paid to the theoretical framework used for pre-test psychological counselling in Leuven. We discuss three important interacting dimensions of psychological counselling: individual emotional support, decision counselling and suppor t of the family communication process. Decision counselling consists of an evaluation of the cognitive and the emotional processing of the information given and strategies and resources for coping. This serves as a starting p oint to facilitate free informed decision making. Scenario development is u sed as a decision aid.