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et al. 1980 ). Closed questions explore specific details, “Do you have any children?,”
or they ask about explicit or implied choices such as, “Are you going to have the
test done?” (Hughes et al. 1997 ). Thus, closed questions constrain the patient’s
response. Closed questions are useful for several reasons including when you need
a specific piece of information, when you wish to constrain a rambling or overly
verbose patient who is not really answering a previous question, for silent patients,
and for content that is uncomfortable or embarrassing for the patient (Brown 1997 )
(e.g., “What I’m really looking for in your family history is anyone with...”;
“Because some conditions occur more frequently in certain ethnic populations, we
always ask...”).
Variations of closed questions include forced choice and rating questions
(Brown 1997 ). Forced choice questions require a patient to respond to one of
two options that you present (e.g., Do you want to do the CF carrier test only or
have the full Jewish Ancestry panel carrier test?) rather than a simple yes or no
(Brown 1997 ).
Rating questions ask patients to estimate their behaviors, feelings, beliefs, and/or
attitudes on some sort of scale (Brown 1997 ). For example, you might ask “On a
scale of 1(very uncomfortable) to 10 (very comfortable), how are you feeling about
your decision to share this information with your family?”
Open-ended questions are questions patients cannot easily answer with a “yes,”
“no,” or one- or two-word response. Typically, open questions begin with words
such as “How,” “What,” “Tell me about,” and “I’m wondering about.” Open ques-
tions explore processes. They enrich the interview by inviting patients to freely
express their views and experiences. Open questions encourage patients to fill in the
gaps with respect to their feelings, thoughts, and situations. For example, you might
ask, “How do you feel about the results of your test? Open questions can help
patients disclose more fully; they can elicit concrete, detailed information and help
you to better understand your patient’s situation.
Sternlight and Robbennolt ( 2008 ) offer suggestions for lawyers when interview-
ing clients, and their recommendations are relevant for genetic counselors. For
instance, they stress the importance of using open-ended questions. “Such questions
are useful, from a psychological standpoint, for a variety of reasons. First, they
allow clients to tell the story in the order that makes sense to them...This will
encourage clients to tell a more complete story...aid clients’ recall...allow clients to
provide a level of detail with which they are confident...allow clients to explain
their...concerns...and deter attorneys from putting their clients’ stories into pre-
existing schema...” (p. 540).
Open-ended questions are effective in guiding patient narratives. Djurdjinovic
( 2009 ) discusses the importance of giving genetic counseling patients the opportu-
nity to tell their story in their own words. “It is the patient telling a personal story
and our attuned listening that allows for assessment of concerns and emotional
issues” (p. 136).
5 Gathering Information: Asking Questions