Application of motivational interviewing strategies with the extended parallel process model to improve risk communication for parents of children with familial hypercholesterolemia

Abstract

Current genetic counseling practice has not been found to significantly increase risk communication between family members. A more diverse set of genetic counseling approaches may be needed. A genetic counseling intervention based on motivational interviewing principles and the extended parallel process model was utilized to increase cascade outcomes within families with familial hypercholesterolemia, a common, underdiagnosed, and treatable condition. Parents of children with familial hypercholesterolemia were invited to participate in an online pre-survey, singlesession genetic counseling intervention, and post-intervention surveys as a part of the CHEERS (Cholesterol Evaluation to Explore Risk Screening) intervention. This study investigated the efficacy of a genetic counselor delivered motivational interviewing intervention and how parents of children with familial hypercholesterolemia react by assessing family member cholesterol screening and risk communication to at-risk relatives. Transcripts were audio-recorded, transcribed, and analyzed for change talk using the Motivational Interviewing Skill Code version 2.1. Participant surveys were analyzed for self-reported extended parallel process constructs and motivations.Coincidence analysis was conducted to explore differences between those with and without positive cascade outcomes within 12 months after the intervention. On average, change talk increased during the session in order of the extended parallel process constructs (perceived severity, susceptibility, response efficacy, self-efficacy).Coincidence analysis revealed that 6 of the 7 cases with positive cascade outcomes were explained by either the presence of high change talk during the intervention or presence of positive motivations shortly after, while 5 of the 5 cases without a positive outcome lacked both of these key factors that were associated with cascade outcomes. Results of this study suggest that incorporating motivational interviewing and the extended parallel process model increases change talk and that the presence of either high levels of change talk or positive motivations is associated with positive cascade outcomes.

Beyond multiple choice: Clinical simulation as a rigorous and inclusive method for assessing genetic counseling competencies

“…Incorporating standardized simulations for summative evaluation in GC programs could allow for assessment consistency in competency-based student evaluation and potentially be a means of demonstrating competence to obtain certification. et al, 2006), motivational interviewing (Winchester et al, 2022), appropriate psychological counseling and literacy levels training (Riddle et al, 2021), an evidence-based psychotherapeutically oriented counseling approach (Austin, 2020), and patient-centered communication skills (Lowe et al, 2023). The communication and counseling-related skills taught in studies such as those may be the most ideal targets for the development of simulation-based assessments of entry-level GC competence.…”

“…Programs should use tools that promote and evaluate counseling competencies, and which do not suppress individual styles or viewpoints. Although more work needs to be done to investigate best pedagogical approaches for counseling skills in genetic counseling, studies have shown beneficial effects in the areas of tailoring communication through video‐supported feedback (Pieterse et al., 2006), motivational interviewing (Winchester et al., 2022), appropriate psychological counseling and literacy levels training (Riddle et al., 2021), an evidence‐based psychotherapeutically oriented counseling approach (Austin, 2020), and patient‐centered communication skills (Lowe et al., 2023). The communication and counseling‐related skills taught in studies such as those may be the most ideal targets for the development of simulation‐based assessments of entry‐level GC competence.…”

Motivational interviewing for genetic counseling: A unified framework for persuasive and equipoise conversations

“…Change, while more commonly thought of in terms of reducing a risk behavior like substance misuse or adding a protective behavior such as physical activity, could also apply to undergoing genetic testing. There has been some conceptual work discussing the role of MI for GC (Ash, 2017) and some qualitative and pilot studies in the GC realm, largely focused on familial hypercholesterolemia and cancer (de Geus et al, 2016;Kinney et al, 2014;Kruger et al, 2019;Razo-Mejia et al, 2014;Resta et al, 2006;Schwartz et al, 2014;Winchester et al, 2022). In MI much of the psychologic work, that is, problem-solving and action planning is done by the patient.…”

“…More recently, there has been increased discussion regarding a potential role for incorporating more persuasion or directionality within GC, around both proband testing as well as family communication and cascade testing (Ash, 2017; de Geus et al, 2016; Kinney et al, 2018; Kruger et al, 2019; Winchester et al, 2022). The rationale for “persuasive GC” is based on the premise that some genetic tests provide actionable information that would clearly benefit patients and families.…”

“…An example is shown in supplement 1. Importantly, as we will describe later, different MI skills and strategies may be applicable across the different types of GC encounters (Ash, 2017; Baldry et al, 2021; Kruger et al, 2019; Winchester et al, 2022). We now describe MI and then discuss how it can be implemented within the context of both persuasive and equipoise GC encounters.…”