Multicultural genetic counseling: Then, now, and in the 21st century

Abstract

Scholars, educators, and practitioners have argued that racial-cultural issues are obstacles for those seeking genetic counseling. When available, cross-cultural genetic counseling has focused on simplistic knowledge of client health beliefs and cultural customs, professional cultures, and biased theoretical models as reasons for failure to create realistic knowledge of members of racial-cultural groups in the United States. Recognizing the importance of meeting the needs for all who seek genetic counseling services, genetic counselors have been providing direction in cross-cultural genetic counseling research, practice, training, and developing competency, ethical, and professional guidelines. However, emanating from a cultural pluralism perspective, cross-cultural genetic counseling has often resulted in homogenized group stereotypes without attention to intragroup variation and individual differences. A transition from cross-cultural towards multicultural genetics shifts from culture-specific group norms to an integrated social, historical, psychological, and political perspective. By valuing the process of personal and professional racial-cultural identity development, the evolution from cross-cultural to multicultural genetic counseling that has occurred within the past quarter century is discussed.

Ethnic, Racial and Cultural Identity and Perceived Benefits and Barriers Related to Genetic Testing for Breast Cancer among At-Risk Women of African Descent in New York City

“…As described earlier, this research builds upon the evolving field of multicultural genetic counseling and transitions away from the assessment of traditionally visible racial and cultural groups to understand a more fully integrated cognitive-affective racial and cultural identity. From this multicultural perspective, greater consideration is given to the range of variation among racial and cultural groups [30]. In fact, a review of existing literature related to genetic counseling by Wang [30] found that only 9% of articles discussed cultural issues; meanwhile, amongst those few who did, 75% considered a cross-cultural, group-specific approach rather than one which values understanding variation among group members.…”

“…In fact, a review of existing literature related to genetic counseling by Wang [30] found that only 9% of articles discussed cultural issues; meanwhile, amongst those few who did, 75% considered a cross-cultural, group-specific approach rather than one which values understanding variation among group members. The study results presented here, which treat ethnic, racial and cultural identity as distinct, but closely related constructs, thus, uniquely add to the multicultural counseling literature by following the shift from exploring race alone to understanding the impact of ethnic, racial and cultural identities [30,36,39]. …”

“…These findings suggest that other ethnic, racial and cultural identity factors may also influence culturally relevant attitudes about genetic testing in this group. Furthermore, the evolving field of multicultural genetic counseling has recently made calls for the incorporation of the client’s psychological view of his/her racial and cultural group as the main indicators of culture over racial phenotype [30], underscoring the importance of studies to determine the influence of these factors on beliefs and attitudes about genetic services. Better understanding of how ethnic, racial and cultural identity factors influence benefits and barriers to genetic testing will help inform the development of culturally-sensitive interventions for diverse groups of women of African descent [8,18,20,21] and ultimately contribute to more culturally competent care.…”

“…Included under the umbrella of ethnic identity is often other-group orientation, as research shows that understanding the attitudes African Americans have toward other ethnic and cultural groups is a necessary component to understanding African-American ethnicity [36]. Racial identity theory accepts a race-based cultural typology, in which identity is understood as a function of racialized experiences based on the assumption that ‘experience of belonging to a racial group transcends all other experiences’ [30,38]. Other research suggests that although phenotypical traits are a salient aspect of identity for individuals of African descent, racial identity is closely aligned with cultural identity rooted in an Afrocentric worldview paradigm [36,39].…”

Identifying and Addressing Genetic Counseling Challenges among Indigenous People of Oaxaca—One Center's Experience with Two Immigrant Farmworker Families in the Central Valley of California

“…This makes the utilization of a cultural broker (someone familiar with the culture and language of both the clinical team as well as that of the target population, who can help bridge the cultural and linguistic differences) vitally important because genetic counseling is predicated on effective communication and building rapport (Jezewski and Sotnik 2001; Kowal et al 2015; Mittman et al 1998; Penn et al 2010; Port et al 2008). Recognition, acceptance, and incorporation of cultural differences into the genetic counseling session optimize the delivery of appropriate care (Catz et al 2005; Chapple et al 1995; Richards and Ponder 1996; Sue and Sue 2015; Wang and Marsh 1992; Wang 2001; Weil and Mittman 1993; Weil 2001). …”