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Exploring Family Relationships in Cancer Risk Counseling Using the Genogram¹

Division of Population Science, Family Risk Assessment Program, Fox Chase Cancer Center, Cheltenham, Pennsylvania 19012 [M. D., C. H. S., S. M., M. I., J. W. C., A. R., A. B., D. G.], and the Division of Medical Genetics, University of Pennsylvania Health System, Philadelphia, Pennsylvania 19104 [J. F.]

Objectives. The genogram is a tool that has facilitated counseling in family therapy and social work for many years. It is hypothesized that genograms may also be useful in genetic counseling, because they help the counselor to acquire more objective and consistent information from the client, as well as to incorporate family dynamics and psychosocial issues into the counseling approach.

Materials and Methods. A pilot study of genograms used as an adjunct to genetic counseling was performed at Fox Chase Cancer Center’s Family Risk Assessment Program. A questionnaire was developed to elicit genograms from 38 women at risk for familial breast and/or ovarian cancer. After standard pedigree expansion, a series of questions was asked about the consultand’s relationship with other family members, communication patterns within the family, attitudes toward genetic testing, family reactions to cancer, roles individuals play in the family, and significant historical or anniversary events. Relationships were defined by the consultand as close, very close, conflictual, fused and conflictual, distant, or estranged.

Results. The majority of relationship types reported by 38 individuals was "very close" or "close." Eighty-one % reported having close/very close relationships with their spouses, 83% reported close/very close relationships with their mothers, and 70% reported close/very close relationships with their fathers. The degree of familial cohesion as depicted by the genogram correlates positively with scores obtained on the standardized Social Adjustment Scale Self-Report (P = 0.01).

Conclusions. Given the family-wide implications of genetic testing, the genogram may offer important guidance in family-targeted interventions.

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