Abstract
Research shows couple conflict occurring during prenatal genetic counseling sessions may be challenging for some genetic counselors. Yet, no study has explored couple conflict in depth. The current study investigated genetic counselors’ experiences and perceptions of the nature and context of couple conflict in prenatal sessions and counselor conflict management strategies. Sixteen prenatal genetic counselors recruited through the National Society of Genetic Counselors participated in semi-structured phone interviews asking about how they recognize couple conflict; topics that trigger conflict and when it occurs; individual, cultural, and situational factors associated with conflict; conflict management strategies; and specific examples from their practice. Inductive and cross-case comparison methods revealed a number of themes. Genetic counselors recognize couple conflict through non-verbal and verbal cues, and conflict can occur at any time, particularly during decision-making about testing and test results and during results review of an affected pregnancy. Factors associated with conflict include cultural customs, age, emotional state, religious beliefs, and being forced to attend counseling. Participants identified 23 conflict management strategies classified into five themes: facilitate decision-making, encourage couple expression, act within one’s scope of practice, provide psychosocial support, and support the identified patient. Counselors emphasized that their strategies are couple dependent. Patients may benefit from genetic counselors assessing couple conflict and intervening when it impedes genetic counseling goals. Clinical examples from this study may contribute to informing genetic counselor practice, program curricula, and continuing education workshops.
Similar content being viewed by others
References
Abad-Perotin, R., Asunsolo-Del Barco, A., & Silva-Mato, A. (2012). A survey of ethical and professional challenges experienced by Spanish health-care professionals that provide genetic counseling services. Journal of Genetic Counseling, 21(1), 85–100.
Alliman, S., McCarthy Veach, P., Bartels, D. M., Lian, F., James, C., & LeRoy, B. S. (2009). A comparative analysis of ethical and professional challenges experience by Australian and U.S. genetic counselors. Journal of Genetic Counseling, 18(4), 379–394.
Bennett, S. M., Litz, B. T., Sarnoff Lee, B., & Maguen, S. (2005). The scope and impact of perinatal loss: Current status and future directions. Professional Psychology: Research and Practice, 36(2), 180–187.
Bower, M. A., McCarthy Veach, P., Bartels, D. M., & LeRoy, B. S. (2002). A survey of genetic counselors’ strategies for addressing ethical and professional challenges in practice. Journal of Genetic Counseling, 11(3), 163–186.
Green, R. M., & Thomas, A. M. (1997). Whose gene is it? A case discussion about familial conflict over genetic testing for breast cancer. Journal of Genetic Counseling, 6(2), 245–254.
Gschmeidler, B., & Flatscher-Thoeni, M. (2013). Ethical and professional challenges of genetic counseling—The case of Austria. Journal of Genetic Counseling, 22(6), 741–752.
Hill, C. E., Knox, S., Thompson, B. J., Nutt Williams, E., & Hess, S. A. (2005). Consensual qualitative research: An update. Journal of Counseling Psychology, 52, 196–205.
Humphreys, L., Cappelli, M., Hunter, A. G. W., Allanson, J., & Zimak, A. (2003). What is the significance of attendance by the partner at genetic counselling for advanced maternal age? Psychology, Health & Medicine, 8(3), 266–278.
Kenen, R., Smith, A. C. M., Watkins, C., & Zuber-Pittore, C. (2000). To use of not to use: Male partners’ perspectives on decision making about prenatal diagnosis. Journal of Genetic Counseling, 9(1), 33–45.
Kusumaningrum, N., Choi, C., & Yeo, G. S. H. (2014). Male partners’ involvement toward prenatal screening and diagnostic testing for down syndrome. Journal of Nursing, 4(2), 755–766.
Lafans, R. S., McCarthy, V. P., & LeRoy, B. S. (2003). Genetic counselors’ experiences with paternal involvement in prenatal genetic counseling sessions: An exploratory investigation. Journal of Genetic Counseling, 12(3), 219–242.
McCarthy Veach, P., Bartels, D. M., & LeRoy, B. S. (2001). Ethical and professional challenges posed by patients with genetic concerns: A report of focus group discussions with genetic counselors, physicians, and nurses. Journal of Genetic Counseling, 10(2), 97–119.
Muller, C., & Cameron, L. D. (2015). It’s complicated—Factors predicting decisional conflict in prenatal diagnostic testing. Health Expectations, 19(2), 388–402.
Patton, M. Q. (1990). Qualitative evaluation and research methods (2nd ed.). Newbury Park: Sage Publications.
Pivetti, M., & Melotti, G. (2013). Prenatal genetic testing: An investigation of determining factors affecting the decision-making process. Journal of Genetic Counseling, 22(1), 76–89.
Pivetti, M., Montali, L., & Simonetti, G. (2012). The discourse around usefulness, morality, risk and trust: a focus group study on prenatal genetic testing. Prenatal dignosis, 32(12), 1205-1211.
Schema, L., McLaughlin, M., McCarthy Veach, P., & LeRoy, B. S. (2015). Clearing the air: A qualitative investigation of genetic counselors’ experiences of counselor-focused patient anger. Journal of Genetic Counseling, 24(5), 717–731.
Sheets, K. B., Crissman, B. G., Feist, C. D., Sell, S. L., Johnson, L. R., Donahue, K. C., et al. (2011). Practice guidelines for communicating a prenatal or postnatal diagnosis of down syndrome: Recommendations of the National Society of genetic counselors. Journal of Genetic Counseling, 20, 432–441.
Sorenson, J. R., & Wertz, D. C. (1986). Couple agreement before and after genetic counseling. American Journal of Medical Genetics, 25, 549–555.
Steinberg Warren, N. (2011). Introduction to the special issue: Toward diversity and cultural competence in genetic counseling. Journal of Genetic Counseling, 20(6), 543–546.
Wilson, K. L., Czerwinski, J. L., Hoskovec, J. M., Noblin, S. J., Sullivan, C. M., Harbison, A., et al. (2013). NSGC practice guidelines: Prenatal screening and diagnostic testing options for chromosome aneuploidy. Journal of Genetic Counseling, 22, 4–15.
Acknowledgements
This study was completed in partial fulfillment of the requirements of the first author’s Masters of Science degree from the University of Minnesota. We would like to thank the genetic counselors who participated in this study.
Dr. Christina Palmer served as Action Editor on the manuscript review process and publication decision.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
Kara Schoeffel, Patricia McCarthy Veach, Karol Rubin, and Bonnie LeRoy declare they have no conflict of interest.
Human Studies and Informed Consent
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 (5). Informed consent was obtained from all participants for being included in the study.
Animal Studies
No animal studies were carried out by the authors for this article.
Rights and permissions
About this article
Cite this article
Schoeffel, K., McCarthy Veach, P., Rubin, K. et al. Managing Couple Conflict During Prenatal Counseling Sessions: An Investigation of Genetic Counselor Experiences and Perceptions. J Genet Counsel 27, 1275–1290 (2018). https://doi.org/10.1007/s10897-018-0252-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10897-018-0252-6