We describe the development of a psychoeducational intervention (PEI) to increase uptake of genetic counseling targeted to high-risk breast cancer survivors. Based on previous research, scientific literature, and a review of cancer education websites, we identified potential PEI content. We then assessed the initial acceptability and preference of two booklets of identical content but different layouts, by presenting the booklets to individuals with a personal or family history of breast cancer (n=57). The preferred booklet was evaluated by two focus groups of ten breast cancer patients who had not attended genetic counseling. The booklet was refined based on participants' feedback at each stage. Focus group participants generally found the booklet visually appealing, informative, and helpful, but some thought that it was too long. Final changes were made based on learner verification principles of attraction, comprehension, cultural acceptability, and persuasion. This project produced an interventional tool to present key constructs that may facilitate decision making about risk-appropriate genetic counseling uptake among high-risk breast cancer survivors. The process described for creating, testing, and adapting materials from a patient perspective can be used for developing other PEIs. This newly developed, unique PEI can be used in many clinical settings.

Purpose: Uptake of genetic counseling among breast cancer survivors is low. We used the Health Belief Model (HBM) to explore factors associated with readiness for genetic counseling among breast cancer survivors. Methods: Breast cancer survivors meeting NCCN genetic counseling referral criteria were recruited through clinics and community settings. Participants completed questionnaires capturing demographic and clinical information and factors guided by the HBM, including health beliefs, psychosocial variables, and cues to action. Using logistic regression, we examined whether the above variables differed based on readiness group (pre-contemplators, who did not plan to make a genetic counseling appointment, and contemplators, who planned to make a genetic counseling appointment in the next 1– 6 months). Results: Of 111 participants, 57% were pre-contemplators and 43% were contemplators. In the multivariable model, higher cancer worry was associated with increased odds of being a contemplator (OR=2.99; 95% CI=1.37–6.54) and higher perceived barriers to genetic counseling were associated with decreased odds of being a contemplator (OR=0.31; 95% CI= 0.11–0.85). Those who reported a family member encouraged them to get tested were more likely to be contemplators (OR=3.57; 95% CI=1.19– 10.70). Conclusions: Our results suggest key factors for predicting genetic counseling readiness include cancer worry, perceived barriers, and family influence. Implications for Cancer Survivors: Ideally genetic counseling occurs prior to treatment, but significant advantages exist for survivors. There is need for increased genetic counseling awareness. Better understanding of factors related to survivors’ decisions about counseling can inform tailored interventions to improve uptake and ultimately reduce cancer recurrence risk.

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