Family stories and the use of heuristics: women from suspected hereditary breast and ovarian cancer (HBOC) families
Open Access
- 3 November 2003
- journal article
- research article
- Published by Wiley in Sociology of Health & Illness
- Vol. 25 (7) , 838-865
- https://doi.org/10.1046/j.1467-9566.2003.00372.x
Abstract
The practice of medicine will increasingly be medicine of the family rather than the traditional physician/patient dyad, especially where a genetic condition is involved. This study explores how clients from suspected hereditary breast and ovarian cancer (HBOC) families seeking cancer genetics risk counselling are influenced by family stories and the use of heuristics (inferential shortcuts used to make sense of complicated information) in interpreting and applying genetic information they receive, and suggests ways in which genetic counsellors can integrate family context into their traditional counselling practices. We conducted an exploratory, qualitative study at a major clinical and research cancer centre in the United Kingdom from January to June 2000 which was reviewed by the hospital clinical research and ethics committees. Twenty‐one semi‐structured, in‐depth interviews were conducted using a purposive sample of women coming to the cancer genetics clinic for the first time, supplemented by five months of clinical observation at weekly clinics. In addition to many family stories based on the number and outcomes of the cancers in their families, we noted: (1) fragments of stories, (2) secret stories, (3) emerging explanations and (4) misconceptions. We did not find widespread intergenerational family myths. The women used three main heuristics in interpreting their breast/ovarian cancer risk: (1) representativeness, (2) availability and (3) illusion of control, as well as what Kahneman refers to as the Peak and End rule. Recent psychological research indicates that illusions of control may have positive affects on both physical and mental health. This may pose a future ethical issue for genetic counsellors in determining how to balance the benefit of positive illusions with the delivery of statistical probabilities of risk.Keywords
This publication has 39 references indexed in Scilit:
- We are talking, but are they listening? Communication patterns in families with a history of breast/ovarian cancer (HBOC)Psycho‐Oncology, 2003
- Genetic Testing for Breast and Ovarian Cancer Predisposition: Cancer Burden and ResponsibilityJournal of Health Psychology, 2002
- Collective Fear, Individualized Risk: the social and cultural context of genetic testing forbreast cancerNursing Ethics, 2000
- Families and genetic fate: A millennial challenge.Families, Systems, & Health, 1999
- Screening by mammography, women with a family history of breast cancerEuropean Journal Of Cancer, 1998
- A conceptual framework for the psychosocial issues faced by families with genetic conditions.Families, Systems, & Health, 1998
- A Qualitative Assessment of Primary Care Physicians' Perceptions about the Ethical and Social Implications of Offering Genetic TestingQualitative Health Research, 1995
- Illusion of control: Invulnerability to negative affect and depressive symptoms after laboratory and natural stressors.Journal of Abnormal Psychology, 1992
- Genetic counseling: Provision and reception of informationAmerican Journal of Medical Genetics, 1979
- The illusion of control.Journal of Personality and Social Psychology, 1975