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5.1.2 Functions of Questions in Genetic Counseling
As mentioned earlier, questions serve a variety of purposes in genetic counseling.
They help with concrete exploration of a patient’s situation, and they provide neces-
sary information to allow you and the patient to determine goals (e.g., identifying
what would be helpful for the patient) and taking action on those goals (e.g., patient
decision-making). The more information you have about patients’ concerns, feel-
ings, motivations, and factors that affect decision-making, the more valid your
assessment will be of their goals, and the more helpful you will be in assisting
patients in their decision-making processes. In genetic counseling, effective use of
questions is also important for gathering information for diagnosis and genetic risk
assessment, such as collecting family and medical history.
Wubbolding ( 1996 ) lists four functions of questions:
- To enter the patient’s world by asking about their wishes, desires, perceptions,
behaviors, etc.
Example: How are you dealing with your fears about possibly having the breast
cancer gene? - To gather information.
Example: Have you had any previous pregnancies? - To give information. Sometimes questions subtly communicate information.
Example: Tell me how you will talk with your child’s teachers about his PKU
diet challenges. (This question suggests the patient has the knowledge and
resources to advocate for her child.) - To help patients gain more effective control.
Example: Please talk about who will be supporting you at home. (This question
encourages the patient to formulate an action plan.)
Questions to Obtain Medical and Family History
Questions are most useful when you use them strategically, with a purpose that is
clear to you and to your patient. Strategic questioning is particularly appropriate
during the family and medical history taking and pedigree construction phase of
genetic counseling. This is a highly structured phase of the session in which you use
questions to gather specific information from your patients. In order to manage
patient expectations, you should explicitly tell patients you will be asking a series of
questions to help you understand their medical and family history. For a compre-
hensive overview of gathering family history, pedigree construction and risk assess-
ment based on family history, see Bennett ( 2010 ).
Family history taking is an essential component of genetic counseling because it
provides “a basis for making a diagnosis, determining risk, and assessing the needs
for patient education and psychosocial support” (Schuette and Bennett 2009 , p. 37).