Oral literacy demand of prenatal genetic counseling dialogue: Predictors of learning

Objective

To assess the relationship between the oral literacy demand of genetic counseling sessions and the ability of low literate subjects to learn genetics-related information.

Methods

Ninety-six simulated genetic counseling sessions were videotaped and shown to 312 subjects recruited to imagine themselves as the session's client. Study measures included oral literacy demand, operationalized as: (1) use of key genetics terms; (2) informational context; (3) general language complexity; and (4) structural characteristics of dialogue interactivity. The study outcome was learning of genetics-related information.

Results

Subjects with restricted literacy (below 8th grade level) learned more when viewing sessions with greater dialogue interactivity and more personally contextualized information. Subjects with adequate literacy skills, however, tended to learn less in low literacy demand sessions.

Conclusion

The oral literacy demand of medical dialogue represents a learning obstacle to low literate subjects. However, this may not be the case for those with greater literacy skills who can understand the complex language and process the dense informational load of high demand sessions.

Practice implications

In order to meet the educational needs of all patients, clinicians must attend to both the informativeness and the oral literacy demand of their communication.     

Individuation and implicit racial bias in genetic counseling communication

ObjectivesGenetic counselors (GCs) can frame information in either general terms (i.e., population risks) or individual terms (i.e., tailoring to specific client characteristics). We investigated whether informational framing might reflect GCs’ implicit racial bias.MethodsWe analyzed previously videotaped genetic counseling sessions with white and minority (Black and Latino) simulated clients (SCs) and modeled the relationship between sixty GCs’ implicit racial bias, as measured by the Implicit Association Test (IAT), and informational framing (general or individual) as characterized by the Roter Interaction Analysis System.ResultsHigher (more pro-white) IAT scores predicted less informational individuation for minority relative to white SCs. Similarly, higher IAT predicted fewer facilitation and activation statements to minority relative to white SCs. With higher IAT-scoring GCs, minority SCs disclosed less psychosocial and lifestyle information, and asked fewer medical questions (all p < 0.05).ConclusionGCs’ racial implicit bias may be associated with less individualized communication style when counseling minority clients.Practice implicationsFuture research should address whether increasing informational individuation can ameliorate negative consequences of implicit bias and help providers reframe perceptions of minority patients in individual rather than categorical terms.     

Adaptation and preliminary validation of the genetic counseling outcome scale (GCOS-24) in a Brazilian genetic counseling setting

Health professionals working in services providing genetic counseling need objective instruments to assess genetic counseling outcomes and also to “give a voice” to those using these services. Lack of knowledge regarding such outcomes may directly impact the effectiveness and the potential benefits of counseling, quality of life, health promotion, and empowerment of those receiving counseling. There are very few instruments available for most countries, however there are none in Brazil. In this context, this study aimed to adapt and preliminarily validate the Genetic Counseling Outcome Scale (GCOS-24), a Patient-Reported Outcome Measure (PROM), originally developed in British English. This methodological study recruited 278 individuals attending a medical genetic service at a Brazilian university hospital. We performed the translation, back-translation, semantic validation, pilot study and field study for testing of some psychometric properties. The instrument's internal consistency and test-retest reliability (stability) were assessed using Cronbach's alpha coefficient and Intraclass Correlation Coefficient, respectively. The Brazilian version of the GCOS-24 presented face and content validity, satisfactory internal consistency (Cronbach's α = 0.71), and moderate stability (ICC = 0.52). It was considered reliable, easily understood and relevant to assessing the genetic counseling outcomes for the study participants. Its construct validity still needs to be assessed to verify the instrument's internal structure and its potential use to measure change in empowerment following genetic counseling provided by Brazilian clinical genetics services.     

Hedging,knowledge and interaction: Doctors’ and clients’ talk about medical information and client experiences in genetic counseling

Objectives

The article starts from the observation that professionals in genetic counseling deploy the strategy of ‘hedging’. It shows how hedging is used in a particular sequential position: doctors’ responses to clients’ presentations of personal information during information delivery sequences.

Methods

The data consist of video-recorded sessions of genetic counseling. The methodology is based on ethnomethodological conversation analysis. The analysis identifies interactional patterns in the counseling sessions.

Results

In their responses doctors display an orientation to different access to different kinds of knowledge. In particular, the doctors tread carefully when commenting on the situation of a particular client vis-á-vis the symptoms and prognosis of genetic conditions. Furthermore, the article shows that the doctors’ responses and hedging devices in them are fitted to the form and function of the clients’ presentations of personal experience.

Conclusion

While the focus of the article is narrow in that it concentrates on one type of an interactional sequence, its strength is that it shows how the doctor's talk can be intertwined with the client's contributions.

Practice implications

The results make it possible for genetic counselors to identify an interactional task they recurrently face and reflect on alternative ways of responding to it.     

The role of genetic counseling on decisions of pregnant women aged 35 years or over regarding amniocentesis in Turkey

We investigated the effects of genetic counseling given before amniocentesis that is given based on maternal serum screening (using the cut-off value of 1/250) and genetic sonogram results (+/- abnormal ultrasound marker) on pregnant women who are 35 years and older age. Their attitudes towards amniocentesis after genetic counseling were evaluated. Among 340 women, 223 (65.6%) were in the high-risk group and 117 (34.4%) were in the low-risk group according to non-invasive test results. After counseling, 216 pregnant women (167 cases have high-risk, 49 cases who had low-risk) decided to have amniocentesis while 124 women (56 with high-risk and 68 with low-risk) declined it. Fourteen abnormal karyotypes were detected. All pregnant women who had fetuses with chromosomal aberrations were in high-risk group. Our study shows that screening by non-invasive prenatal diagnostic tool has an effect on families' choice of amniocentesis. The use of these test results during counseling decreased the number of amniocentesis in a ratio of 36.5%.     

宁德地区206例遗传咨询者细胞遗传学分析

目的探讨染色体异常在不良生育,习惯性流产,智力低下,发育异常和先天畸形等病人中的发生情况.方法取患者外周血进行淋巴细胞培养,常规收获,G显带,显微镜下进行核型分析.结果 206例病人中共检出异常核型20例,异常检出率9.71%.结论结果表明染色体异常,多伴有多发畸形及智力低下,也是引起流产、死胎的重要原因.做好遗传咨询,将有助于减少先天缺陷儿的出生,对提高人口素质有重要意义.     

The effect of numeracy on the comprehension of information about medicines in users of a patient information website

Objective

To investigate the relationship between numeracy and the accuracy of side effect risk estimation following the presentation of information about a medicine via the Cancer Research UK (CR-UK) patient information website.

Methods

591 website users were presented with information in different formats about the risks of side effects from taking tamoxifen. Participants estimated the risk of each side effect, provided other subjective ratings about the information and completed a numeracy task.

Results

Regardless of presentation format, numeracy was correlated with the accuracy of three side effect risk estimates. People with cancer and tamoxifen users showed stronger correlations for all side effect estimates. In addition, numeracy was positively related to the perceived influence of the information on the decision to take the medicine and was negatively related to ratings of satisfaction with the information.

Conclusion

People with a lower numeracy level make larger errors in interpreting medicines side effect risk information.

Practice implications

Pharmacists, other health professionals and patient information websites should ensure they provide clear explanations of risk, particularly to people with low numeracy, and assess their understanding of those explanations. Future research into risk communication should take account of numeracy level, to investigate the impact of different formats.     

新疆地区4000例遗传咨询患者细胞遗传学分析

目的统计遗传咨询患者染色体异常的类型和发生概率,研究细胞遗传学检查在临床诊断中的应用价值。方法采用常规外周血淋巴细胞培养及染色体制备,G显带,镜下核型分析。结果4000例遗传咨询患者中共检出染色体异常核型540例,检出率为13.50％。其中唐氏综合征92例,占总数的2.30％;特纳综合征22例,占总数的0.55％;平衡易位38例,占总数的0.95％;罗氏易位12例,占总数的0.30％;染色体倒位76例,占总数的1.90％;常染色体多态性变异216例,占总数的5.40％;Y染色体多态性变异70例,占总数的1.75％;另见染色体部分缺失6例,标记染色体3例,衍生染色体2例。结论染色体核型分析结果是临床诊断及优生优育的重要参考依据;进行遗传咨询、产前筛查和产前诊断可有效降低出生缺陷。     

The impact of genetic counseling on knowledge and emotional responses in Spanish population with family history of breast cancer

Objective

To assess a genetic counseling intervention measuring the distress, cancer risk perception, anxiety, worry and level of knowledge in people with familial history of breast cancer.

Methods

One group pre- and post-test design. A total of 212 individuals completed a baseline questionnaire, 88.6% completed a second questionnaire one month later and 75.4% six months later.

Results

Counseling intervention significantly increased the knowledge level of the individuals who received genetic education and significantly decreased the cancer worry levels. Persons with low perception of their cancer risk also had low worry levels. There were no significant changes over time in cancer risk perception or in quality of life.

Conclusion

Counseling in a high risk population seems to decrease cancer worry and to increase cancer knowledge thus enabling a counselee to take well-informed decisions. Furthermore, according to our results, such interventions do not increase anxiety and do not modify the quality of life, but do not adjust their cancer risk perception.

Practice implications

Providing individuals at increased risk of breast cancer genetic services seem to enhance their understanding of breast cancer without causing adverse psychological effects or changes in their quality of life, and it could improve their preventive behaviours.     

5828例遗传咨询者的细胞遗传学分析

目的研究临沂地区遗传咨询患者中染色体异常核型的发生率,探讨染色体异常与疾病发生、发展的关系,为优生优育、降低出生缺陷、提高人口素质服务。方法采用外周血淋巴细胞染色体培养技术,行G显带,必要时进行C显带检查,显微镜下进行核型分析。结果检查5828例遗传咨询患者染色体,就诊原因主要为不良孕产史、不孕不育、原发及继发性闭经、智力低下、先天畸形等,共检出异常染色体核型146种类型805例,检出率为13.81%（805/5828）。检出常染色体结构和数目异常616例,占异常核型的76.52%（616/805）,性染色体结构和数目异常189例,占异常核型的23.48%（189/805）。异常的染色体涉及所有24条染色体。结论染色体异常是导致不良孕产史、不孕不育、性发育异常、智力低下等疾病的重要原因之一,对这些病人进行遗传咨询、生育和康复指导非常必要,以达到提高人口素质的目的。     

温州地区1068例遗传咨询者细胞遗传学研究

目的探讨智力低下、性发育异常、原发闭经及不良孕产史等患者染色体变化的特点和意义。方法采用外周血淋巴细胞培养方法制备染色体,G、C等显带技术进行细胞遗传学分析。结果1068例遗传咨询者染色体异常检出率达16.01%(171/1068)。不同病因的异常核型检出率分别为小睾、无精、少精者49.29%(69/140)、原发闭经者40.00%(30/75)、智力低下者26.67%(8/30)、不良孕产史者8.52%(54/634);171例异常核型中,性染色体数目结构异常71例(占41.52%),常染色体数目结构异常44例(占25.73%),染色体多态性47例(占27.49%),男(女)假两性畸形患者9例(占5.26%)。结论遗传咨询者中染色体异常比率高,染色体异常与原发闭经、无精、性分化异常有密切的关系。对高危人群进行染色体检查,为临床治疗及指导优生具重要意义。     

临沂地区546例遗传咨询儿童的细胞遗传学分析

目的研究临沂地区儿童遗传咨询患者中染色体异常核型的频率和类型,探讨染色体异常与疾病发生、发展的关系,为优生优育、降低出生缺陷、提高人口素质服务。方法采用外周血淋巴细胞染色体培养技术,行G显带,必要时进行C显带检查,显微镜下进行核型分析。结果检查546例遗传咨询儿童染色体,就诊原因主要为智力低下、生长发育迟缓、尿道下裂、两性畸形、隐睾及其他先天畸形等,共检出异常染色体核型380例（29种核型）,检出率69.60%。其中染色体数目异常300例,占异常核型的78.95%;结构异常31例,占异常核型的8.16%;结构异常合并数目异常3例,占异常核型的0.79%;真、假两性畸形46例,占异常核型的12.10%。结论染色体畸变是引起儿童出生缺陷的重要原因之一,对临床怀疑为染色体综合征的患儿应做染色体检查。     

Goals of genetic counseling

The goals of genetic counseling have differed over the past three decades. Two schools of thought are prominent in reviewing past literature. One upholds the goal of preventing birth defects and genetic disorders while the other promotes a goal of improved psychological well-being in client adaptation to a genetic condition or risk. Both types of goals emphasize that clients should make their own reproductive decisions; however, the former relies on clients making decisions that will reduce the impact of genetic disorders. The differences in the types of goals may be due to the training and orientation of genetics health care providers, socio-cultural views, or priorities of health care settings. Regardless, there are ample reasons to dismiss the prevention of birth defects as a goal. This mini-review recommends use of genetic counseling sub-specialties as a framework for considering different client needs and thus different counseling goals and specific aims in the reproductive, pediatric/adult, and common disease settings. Given the extent of new genetic information, technologies, and the need to evaluate genetic counseling practice, genetics health care providers should work toward arriving at consensus on the goals of genetic counseling, and in doing so, the needs of clients should be considered.     

The rise of the genetic counseling profession in China

The rapid development of genetic and genomic technologies has greatly boosted medical genetic researches and clinical services worldwide. Since last century, genetic counseling in the United States has helped individuals and families understand, accept, and cope with their genetic issues. This fledging profession, which is in essence a branch of social work, emerged in China relatively late but has rapidly grown over the last few years. We believe that genetic counseling will continue to play a pivotal role in building communication channels between medical doctors and their patients, the government and the general public, and social organizations and their customers in China. The growth of genetic counseling aims to enable patients and family members to make informed decision which in turn will lead to the reduction of the birth prevalence of severe congenital anomalies and genetic disorders.     

广东地区10000例遗传咨询者细胞遗传学分析

为探讨广东地区（亚热带地区）遗传咨询人群中,外周血染色体异常核型检出率,为亚热带地区染色体数据库提供相关数据;并探讨阳性检出者与临床的关系,给优生优育干预提供科学依据,我们对1998年1月至2007年8月来我院和中山医学院科技中心就诊的10000例遗传咨询者进行外周血染色体检查,共检出染色体异常核型1102例,占受检人员的11.0%,较我国北方和中部地区的检出率高。     

兰州地区6665例遗传咨询患者外周血淋巴细胞染色体核型分析

目的分析兰州地区近5年遗传咨询患者中染色体异常核型的发生率。方法采用外周血淋巴细胞培养及染色体制备,G显带,必要时进行C显带,显微镜下进行核型分析。结果 6665例遗传咨询患者,共检出异常染色体核型370例,检出率为5.56%。常染色体异常226例,占异常核型的61.08%,性染色体异常65例,占17.57%,染色体多态变65例,占异常核型的17.57%。结论染色体异常是导致智力低下、不良孕产史、性发育异常等疾病的重要原因之一。     

南通地区遗传咨询患儿细胞遗传学分析与临床研究

目的研究遗传咨询患儿中染色体异常核型的发生率。方法本文自2000年1月至2008年2月对174例年龄在14周岁以内的遗传咨询患儿做了外周血淋巴细胞染色体核型分析,通过胰酶消化,G显带,必要时进行C显带检查,显微镜下进行核型分析。结果在因智力低下、性分化异常、身材矮小等前来行遗传咨询的174例患儿中,共检出异常核型61例,异常率35．06％。常染色体结构和数目异常49例,占异常核型的80．33％（49／61）,性染色体结构和数目异常12例,占19．67％（12／61）。男患儿114例,检出异常核型30例,异常率26．32％（30／114）;女患儿60例,异常核型31例,异常率51．67％（31／60）。结论异常染色体是导致智力低下、性发育异常、身材矮小等疾病的重要原因之一,对指导临床诊疗具有重要参考意义,因此染色体检查是十分必要的。     

Prenatal diagnosis of 2q13 duplications: The crucial role of the family survey in genetic counseling on novel copy number variations

In recent years, the introduction of novel genome analysis technologies (such as array comparative genomic hybridization) has enabled the prenatal diagnosis of various recurrent copy number variations (CNVs). Some of these CNVs have been linked to a greater susceptibility of developmental and neuropsychiatric disorders; for example, recurrent duplication at the 2q13 locus is associated with developmental delay, dysmorphism and intellectual disability. However, this CNV has low penetrance and variable clinical expressivity. It also can be observed in healthy controls and can be transmitted by unaffected parents, making genetic counseling especially challenging. Here, we report on the inheritance of a 2q13 duplication in an asymptomatic family; the case highlights the role of the family survey in genetic counseling with regard to novel CNVs diagnosed before birth.