Table.1 Content and process of the PCS and PeACE peer coaching protocols

1

• Clarifying potential communication choices that mothers have (e.g., share all, some, or no information with their children).

• Identifying how values may be derived from multiple sources, including maternal psychological stress reactions/responses to their genetic testing, concern for family communication and well-being, extent to which they value input from spouses/partners, friends.

• Addressing how maternal values and preferences may manifest in decision making needs, including family-of-origin beliefs, cultures, systems.

• Introduction and orientation to the program and working with a peer supporter.

• Recognizing emotional, cognitive, and behavioral sources of hereditary cancer stress.

• Presentation and practicing of problem solving approaches and the content of improving communication, making decisions, and managing distress.

• Navigating the use of the participant workbook to apply problem-solving.

• Assign homework that applies problem-solving techniques.

2

• Exploring issues and needs in communicating genetic test results to children and managing stress:

o Patient types (previvor, newly diagnosed, survivor)

o Implications of risk

o How to assess children’s readiness to learn about hereditary risk

o Communicating risk to children based on child age/gender

o Pros/cons of communicating risk

o Considerations for parents who choose not to communicate with children about BRCA

• Using interactive decision guide worksheets to explore decision making.

• Review of homework problem-solving techniques.

• Reinforce coping strategies:

o Focusing on ways of enhancing coping and decreasing distress

o Identifying healthy and unhealthy coping strategies

o Assess information needs

o Apply cognitive problem-solving training to hereditary cancer risk

• Assign homework that applies problem-solving techniques.

3

• Discussing risk with children if/when the time is right, emphasizing if/how plans meet preferences/values.

• Reviewing communication strategies/conversations that may occur–including consideration of vocabulary and terminology, explaining inheritance, risks, and management options, genetic testing in adulthood, psychological concerns.

• Assessing children’s reactions, helping them cope with/assimilate hereditary risk.

• Referencing useful websites and books.

• Reviewing completed worksheets.

• Enhancing risk comprehension, decision making and managing emotions.

• Specific steps to take to gain information and support about hereditary cancer risk, working with how to anticipate their thoughts and feelings, making plans for next steps.

• Use of vignettes/role-playing techniques, problem-solving, communication, decision making skills training, managing emotions, reinforce resource utilization.