Exploring Genetic Counseling Communication Patterns: The Role of Teaching and Counseling Approaches
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The educational and counseling models are often touted as the two primary professional approaches to genetic counseling practice. Yet, research has not been conducted to examine how these approaches are used in practice. In the present study, we conducted quantitative communication analyses of BRCA1 genetic counseling sessions. We measured communication variables that represent content (e.g., a biomedical focus) and process (e.g., passive listening) to explore whether genetic counselor approaches are consistent with prevailing professional models. The Roter Interaction Analysis System (RIAS) was used to code 167 pre-test genetic counseling sessions of members of a large kindred with an identified BRCA1 mutation. Three experienced genetic counselors conducted the sessions. Creating composite categories from the RIAS codes, we found the sessions to be largely educational in nature with the counselors and clients devoting the majority of their dialogue to providing biomedical information (62 and 40%, respectively). We used cluster analytic techniques, entering the composite communication variables and identified four patterns of session communication: Client-focused psychosocial, biomedical question and answer, counselor-driven psychosocial, and client-focused biomedical. Moreover, we found that the counselors had unique styles in which they combined the use of education and counseling approaches. We discuss the importance of understanding the variation in counselor communication to advance the field and expand prevailing assumptions.
KEY WORDS:communication patterns BRCA1 genetic counseling cluster analysis.
This study was funded by the National Human Genome Research Institute (R03HG002359; Principal Investigator, Lee Ellington). We are grateful to Renn Upchurch and Ryan Beveridge for their coding of all the data and to Amiee Maxwell for her organization and insights. Further, we wish to thank two reviewers for their very thoughtful comments. Last but not least, we would like to thank the participants in this research project for allowing us to audiotape their sessions.
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