Table 1 Principles guiding conduct of cancer screening counseling derived from proven theories

Cognitive dissonance

-Cognitive dissonance is the feeling of psychological discomfort produced by the combined presence of two thoughts that do not follow from one another;

-Produce a dissonant state about cancer and then controls the direction chosen for the dissonance resolution through skilled use of counseling techniques;

-Being psychologically uncomfortable, the existence of dissonance motivates the person to reduce the dissonance and leads to avoidance of information likely to increase the dissonance;

-View ambivalence as not a barrier but a crucial entry point and can be resolved;

-The greater the discomfort is, the greater the desire to reduce the dissonance of the two cognitive elements;

-Elicit the patient’s desires, expectations, beliefs, fears, and hopes, with particular emphasis on the inconsistencies between these and CS;

-Cognitive dissonance about health derives from perceived susceptibility and seriousness of health problems, benefits and effectiveness of behavior change, barriers and efficacy for implementing the change.

-Address all (rather than part) of critical determinants of CS uptake and discuss risk and harms of cancer, effectiveness and benefits of CS, potential barriers and problems to CS, and strategies, tips and resources for overcoming these barriers and problems.

Self-efficacy

-Self-efficacy is a person’s belief that he/she can carry out and succeed at a specific change strategy;

-Respect the patient’s autonomy and rely on his/her own capacities to seek CS.

-People with high efficacy expect to succeed, realize favorable outcomes and vice versa;

-Affirm the patient’s freedom of choice and self-direction.

-People with high efficacy believe that they can overcome obstacles by persevering and by improving self-management skills and they do not give up, but rather “stay the course” in the face of difficulties;

-Ensure that motivation to change is elicited from the patient, rather than imposed from outside;

-Monitor the patient’s motivation and readiness for CS uptake and avoid harsh action plans;

-People with low efficacy believe that their efforts in the face of difficulties will fail and would therefore be a waste of time to undertake and they quickly give up trying.

-Help the patient to verbalize arguments for CS and develop, when ready, a specific plan to utilize CS;

-Offer advice/supports tailored to anticipated barriers or needs for the patient to seek CS.

Accurate sympathy

-Accurate empathy defines skillful reflective listening that clarifies and amplifies the participant’s own experience and meaning, without imposing the counselor’s own material;

-Communicate respect and caring, and builds a working alliance between counselor and participant;

-Encourage the patient to keep talking and exploring key topics, especially ambivalence, about CS,;

-It builds mutual trust between the counselor and participant, enables eliciting true reasons for ambivalence, and enhances participant’s compliance with planned CS uptake.

-Clarify exactly what the patient means and express acceptance and affirmation;

-Seek to understand the patient’s frame of reference, particularly through reflective listening.