Recommended Steps for Screening Women with Breast Cancer for Significant Clinical Problems Document High-Risk Factors • Identify and document high-risk characteristics of the woman (for example, young age, poor social support, children under 21 years of age, economic adversity, past psychiatric problems, and interpersonal problems) • Identify and document high-risk disease characteristics (for example, increased side effects, lymphoedema, and recurrence) Ask about General Functioning Use model questions, such as • In addition to looking at the medical and surgical issues, I am interested in hearing how things are going more generally for you. • How have you been feeling emotionally? • Could you tell me how your mood is? • How are you handling the diagnosis and treatment? Ask about Specific Clinical Issues Use model questions, such as • Diagnosis and treatment for breast cancer is often stressful for the couple and members of the family. Can you tell me how things are at home? How are your partner and family handling it? • Some women find that they get quite depressed during treatment. If that is the case, there are a number of treatments available. Can you tell me how your mood has been? • Although it is often hard to talk about, many women feel concerned about how they look and feel about themselves after surgery and treatment. Can you tell me how you feel about these things? Are these concerns related to your decision about treatment? Have you discussed any concerns with your partner? • Some women have a lot of worries about cancer and the treatment for it. What kind of worries do you have? How are you dealing with these worries? • Having breast cancer affects many aspects of women’s lives. One concern that women have but may find hard to talk about is their sense of themselves as a woman and their intimate relationships. Can you tell me if things like that are worrying you? • One concern women often have but may find hard to talk about is their sex life and intimate relationships. Are you or your partner having any concerns about this area of your life? Refer for Counseling • Tell the woman about the benefits of both individual and group counseling. • Provide the woman with various referrals for individual or group counseling. • Ask the woman if she would like you to help arrange the appointment. • Ask if the woman has any questions about counseling. • Communicate concerns and treatment plan to other members of the treatment team