117- Other—questions that tend to explore patients’ personality and general coping
strategies as well as general family dynamics and future aspirations (e.g., “What
are your feelings about having children?).
Sarangi et al. ( 2005 ) conducted further research on patients’ reactions to genetic
counselor use of reflective frames during HD counseling sessions. They found some
patients “take up the opportunity to engage in self-reflection, and thus endorse the
legitimacy of the reflective frame. At the other extreme, clients may implicitly or
explicitly challenge the relevance of self-reflection” (p. 29). The researchers con-
cluded that some patients have a greater need to “prove their readiness” for predic-
tive testing and thus are more responsive to reflective frames. These findings
illustrate the importance of assessing and respecting individual and cultural differ-
ences with regard to the type and number of questions you ask.
Exploring Perceptions and Values Clarification
Genetic counselors can use questions to assess patient perceptions about genetic
conditions or genetic risk. Questions can also be used to help patients better under-
stand their perceptions and values and to facilitate decisions. Farrelly et al. ( 2012 )
content analyzed 93 transcripts of simulated prenatal patient genetic counseling ses-
sions. The results of this study illustrate the importance of using questions strategi-
cally to facilitate patient and counselor understanding of patient perceptions and
values. For example, many counselors asked patients about their personal experi-
ences with disability, and half of the counselors asked patients if they had thought
about how they might use the results of prenatal screening.
Regarding questions about patients’ personal experiences with disability, the
researchers found that “The majority of genetic counselors (86%) asked the simu-
lated client very general level questions, such as ‘Have you heard of Down syn-
drome?’ or ‘Are you familiar with Down syndrome?’” A smaller number of genetic
counselors (38%) asked personal questions, such as “Do you know someone with
Down syndrome?” Of note, most of the transcripts that demonstrated the genetic
counselor asking about the simulated client’s experience with disability showed
the genetic counselor asking the question, only to move forward without acknowl-
edging or further exploring the client’s response. [Examples from this paper
follow:]
Genetic counselor: So, are either of you familiar with what happens with Down
syndrome? Or are you familiar with Down syndrome at all?
Client: I met some kids with Down syndrome so that’s really about it.
Genetic counselor: OK. Well this is what happens in Down syndrome, why this
test, the amniocentesis, can really give you an answer as to whether the baby has
it or not...5.1 Obtaining Information from Patients