Coming Full Circle: A Reciprocal‐Engagement Model of Genetic Counseling Practice

Abstract

As genetic health care and genetic testing expand from primarily addressing conditions that are exclusively genetic in nature to common diseases with both genetic and environmental components, the scope of genetic counseling has grown. Identification and utilization of a normative model of practice defined by members of the profession is critical as genetic services become more commonplace in medical care. The purpose of this paper is to describe the results of a consensus conference convened to define a model of genetic counseling practice based on the guidance of educators and leaders in the profession. Twenty-three program directors or their representatives from 20 genetic counseling graduate programs in North America listened to presentations and participated in group discussions aimed at determining the elements of a model of practice, including tenets, goals, strategies, and behaviors for addressing patients' genetic concerns. Their discussion is summarized, training implications and research recommendations are presented, and a model of practice that extends their ideas is proposed.

What process attributes of clinical genetics services could maximise patient benefits?

“…23 This conceptualisation of empowerment is consistent with recently identified goals of genetic counselling, which include empowering patients. 34 It is likely that local, accessible services would facilitate appropriate referral. This in turn is likely to facilitate early diagnosis and ensure that families obtain knowledge and information about the family condition, including information about which family members may be at risk for developing or transmitting the condition, thus contributing to empowerment.…”

Conceptualizing Genetic Counseling as Psychotherapy in the Era of Genomic Medicine

“…Further, it is also worth highlighting that-perhaps counterintuitively-counseling oriented practice also positively influences knowledge-based outcomes. Encouraging clients to articulate their feelings seems to facilitate their cognitive processing of the complex medical information provided (Ellington et al 2011;Meiser et al 2008;Veach et al 2007). In a systematic review of interventions to improve risk communication in clinical genetics, Edwards et al (2008) found that supportive or emotional elements of counseling, such as addressing issues of loss, grief and relationship problems, provided greater benefits (including in areas such as knowledge and decision making) than purely informational or educational approaches.…”

Medical management adherence as an outcome of genetic counseling in a pediatric setting

“…14,15 The reciprocal engagement model of genetic counseling proposes that "the genetic counselor and patient make decisions in a collaborative fashion-there is a give and take between counselor and patient. " 16 Because patients involved in collaborating on their medical decisions demonstrate higher satisfaction and better adherence, facilitation of collaborative decision making by GCs may be associated with increased patient adherence.…”