Working with the Hmong Population in a Genetics Setting: Genetic Counselor Perspectives

Abstract

The Hmong language lacks words for many familiar Western medical genetic concepts which may impact genetic counseling sessions with individuals of Hmong ancestry who have limited English proficiency. To study this interaction, a qualitative, semi-structured interview was designed to address genetic counselors' experiences of genetic counseling sessions working with individuals with Hmong ancestry. Genetic counselors in the three states with the largest population of Hmong individuals (California, Minnesota and Wisconsin) were invited via email to participate in a telephone interview. Eleven counselors' interviews were transcribed and analyzed for emergent themes. Each of the counselors had served Hmong patients in a variety of clinics and possessed counseling experience ranging from approximately one to greater than 20 years. Interviews highlighted strengths and challenges in genetic counseling sessions with Hmong patients with limited English proficiency in each of five categories: 1) relevant training during graduate school, 2) session preparation, 3) content of the counseling session, 4) perception of Hmong culture, and 5) reflections on working with Hmong interpreters. Cultural awareness and education in training programs were highlighted by all genetic counselors as valued components to patient care. All interviewees had worked with professional Hmong medical interpreters, but had different expectations for the interpreter with whom they worked. To help improve genetic services for Hmong individuals in the United States, we offer suggestions to improve some of the challenges mentioned, and recommend further studies to investigate the genetic counselor and interpreter relationship.

Communication pitfalls in interpreted genetic counseling sessions

“…When patient and genetic counselor do not use the same language, it is necessary for an interpreter to facilitate communication. This removes the genetic counselor one step from the patient, and additional effort is required to reach an engaged level of communication with the patient (Agather, Rietzler, Reiser, & Petty, ; Veach, Bartels, & LeRoy, ).…”

“…This removes the genetic counselor one step from the patient, and additional effort is required to reach an engaged level of communication with the patient (Agather, Rietzler, Reiser, & Petty, 2017;Veach, Bartels, & LeRoy, 2007).…”

Perspectives on facilitating whole exome sequencing for international patients at Mayo Clinic

“…The vast majority of our international patients do not speak English as a first language, so we cannot use the video to assist with education. These patients then require the use of interpreters, making it much more challenging to convey complex genetic information since some languages lack medical vocabulary for genetic terms (Agather, Rietzler, Reiser, & Petty, ). These factors decrease the amount of time we could spend exploring patients’ goals for WES and assessing their overall understanding.…”

“…The vast majority of our international patients do not speak English as a first language, so we cannot use the video to assist with education. These patients then require the use of interpreters, making it much more challenging to convey complex genetic information since some languages lack medical vocabulary for genetic terms (Agather, Rietzler, Reiser, & Petty, 2017 (Amendola et al, 2015). The phenomenon of disappointment at negative results has been reported as a challenge in WES result disclosure sessions (Wynn et al, 2018), and this may be more difficult to counteract in our inter- (Wynn et al, 2018), and this cannot be completely mitigated during a single genetic counseling session.…”

Beyond Cultural Competency Training and Diversity and Inclusion Statements: The Quality of Genetic Testing for Asian Americans

“…Tailoring to the health concerns of these diverse subgroups can be an overwhelming task. Thus, when confronting the challenges of dealing with Asian patients, health professionals and researchers have eagerly tackled the more surface-level problem of cultural difference (Agather et al, 2017;Chen et al, 2012;Halbert and Harrison, 2018;Mattson and Lew, 1992). They cite cultural barriers as among the reasons that hinder research recruitment or uptake of genetic services such as screening.…”