Geoffrey G. Yager

Family communication about positive BRCA1 and BRCA2 genetic test results

Purpose: The identification of a BRCA1 or BRCA2 genetic mutation can provide important health information to individuals who receive this result, but it can also provide crucial cancer risk information to family members. Most of the research on communication of genetic test results has focused on first degree relatives. The purpose of this retrospective study was to examine the process of communicating a positive BRCA1 or BRCA2 genetic test result to male and female first, second, and third degree relatives.Methods: Participants were 38 female mutation carriers who responded to a written survey assessing the number and relationship of relatives informed, methods used to inform relatives, topics discussed, and motivations and barriers for communication.Results: Overall, 59% (470/803) of first, second, and third degree relatives were informed. The proportion of informed parents, siblings, and offspring was nearly twice that of more distant relatives including nieces, nephews, aunts, uncles, grandchildren, and cousins (88% versus 45%; P = 0.02). The method of communication differed by the gender of the relative, as did some of the topics discussed. The most important reasons for discussing the genetic test results were (1) to inform the relatives of their risk, (2) to suggest that they be tested, and (3) to fulfill a perceived duty to inform. The major barrier to communication was little contact and/or emotionally distant relationships.Conclusion: Female mutation carriers act on a perceived duty to inform close relatives of their positive test result; however, there is a need for genetic counseling strategies that address communication with more distant relatives.

Assessing the equivalence of paper-and-pencil vs. computerized tests: Demonstration of a promising methodology

Abstract A computer-administered version of a test-attitudes screening instrument was examined for generalizability and evaluated against criteria for parallelism with the identical test in paper-and-pencil format. Implications for computerized testing are discussed.

Spiritual Assessment in Genetic Counseling

One hundred and twenty seven full members of the National Society of Genetic Counselors participated in this study exploring current spiritual assessment practices of genetic counselors and reactions to a spiritual assessment tool. While 60% of genetic counselors reported they had performed a spiritual assessment within the past year, fewer than 8.7% of these counselors assessed spirituality in more than half of their sessions. Counselors reporting high perceived relevance of spiritual assessment performed an assessment more frequently than those reporting a low perceived relevance. Barriers to spiritual assessment included lack of time, insufficient skills, and uncertainty regarding the role of spiritual assessment within genetic counseling. Almost two-thirds of counselors expressed that having a spiritual assessment tool would increase their ability to elicit relevant information. These data suggest a need for increased training regarding the methods for and relevance of spiritual assessment in genetic counseling. Recommendations for future directions of research are explored.

The impact of supervision training on genetic counselor supervisory identity development.

Supervision is critical to the training of genetic counselors. Limited research exists on the influence of supervision training and experience on the development of genetic counseling supervisors. The purpose of this study was to investigate the impact of supervision training in addition to supervisory and clinical experience on supervisory identity development, and the perceived confidence and competence supervisors have in their own supervisory skills. In addition, we explored genetic counselors’ (N = 291) interest in and barriers to training as well as perspectives on requirements for supervisors. Results indicated clinical experience, supervision experience, and formal supervision training are positively associated with genetic counselors’ supervisory identity development as measured by the Psychotherapy Supervisory Development Scale (PSDS) (p < 0.05). Despite a moderate correlation between supervision experience and formal training (ρ = 0.42, p < 0.001), both had independent effects on PSDS scores (p < 0.04). A majority of genetic counselors were interested in receiving supervision training but noted lack of available training as a barrier. The majority of participants indicated that supervisors should be certified as genetic counselors, but there was no consensus on training requirements. Development of additional supervision training opportunities for genetic counselors should be considered.Supervision is critical to the training of genetic counselors. Limited research exists on the influence of supervision training and experience on the development of genetic counseling supervisors. The purpose of this study was to investigate the impact of supervision training in addition to supervisory and clinical experience on supervisory identity development, and the perceived confidence and competence supervisors have in their own supervisory skills. In addition, we explored genetic counselors’ (N = 291) interest in and barriers to training as well as perspectives on requirements for supervisors. Results indicated clinical experience, supervision experience, and formal supervision training are positively associated with genetic counselors’ supervisory identity development as measured by the Psychotherapy Supervisory Development Scale (PSDS) (p < 0.05). Despite a moderate correlation between supervision experience and formal training (ρ = 0.42, p < 0.001), both had independent effects on PSDS scores (p < 0.04). A majority of genetic counselors were interested in receiving supervision training but noted lack of available training as a barrier. The majority of participants indicated that supervisors should be certified as genetic counselors, but there was no consensus on training requirements. Development of additional supervision training opportunities for genetic counselors should be considered.

Commentary on “Conceptualizing Genetic Counseling as Psychotherapy in the era of Genomic Medicine”

Before commenting directly on the article by Austin, Semaka, and Hadjipavlou (2014), I need to state my bias on this issue very clearly: As a counselor educator, counseling psychologist, and professional clinical counselor who has taught counseling techniques to genetic counseling students for more than 30 years, I have always strongly endorsed Kessler’s (1997) perspective that genetic counseling incorporates two core functions. The first function is the effective communication of information related to the genetic aspects of a wide variety of medical conditions. This information needs to be accurate, current, and expressed in a way that is understandable to patients who may have no medical or scientific background. The information-giving (teaching) part of genetic counseling is a complex and difficult task in that it not only requires a depth of knowledge but also a high level of interpersonal skill (e.g., reading a patient’s nonverbal confusion after an attempted explanation or recognizing that sometimes a carefully placed question may reveal what the patient is not understanding). The second core function of the genetic counselor task is to serve as a counselor (or psychotherapist), aiding the patient’s exploration of his/her emotional reactions and psychosocial concerns related to the genetic information presented. This second component of a genetic counselor’s work is emphasized in the Accreditation Council for Genetic Counseling (Accreditation Council for Genetic Counseling 2013 ,p p. 3–4) Practice-Based Competencies under Domain II: Interpersonal, Psychosocial and Counseling Skills. This section of the document includes core competencies clearly reflective of psychotherapy skills:

Development and Validation of the Genetic Counseling Self-Efficacy Scale (GCSES)

This study describes the development of a self-efficacy scale that is specific to genetic counseling and based both on Bandura’s self-efficacy theory (2006) and the Accreditation Council for Genetic Counseling practice-based competencies (2013). The phase 1 validation compared genetic counseling students (n = 20) and genetic counselors (n = 18). Nine items were removed from the scale at this point for lack of discrimination or redundancy. The phase 2 validation included a larger cohort of genetic counseling students (n = 168). Factor analysis identified six factors accounting for 58% of the total variance. Cronbach’s alpha as well as the inter-item correlations and item-total correlations of both the full scale items and underlying factors indicated that the items and factors of the scale are sufficiently related, but not redundant. The newly developed Genetic Counseling Self-Efficacy Scale (GCSES) has the potential to be used as an outcome measure in research related to training or professional development of genetic counselors as well as for a training tool.