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- Use questions strategically. Closed-ended questions like, “Do you understand?” or
“Do you have any questions?” are not usually helpful. Most patients will say they
understand, and many will deny having any questions. Instead, try open- ended state-
ments: “What questions do you have?” and “Of the information we’ve discussed so
far, what stands out for you?” Their responses to these questions will give you an
opportunity to correct any inaccuracies and/or reinforce key points they identify. - Refrain from getting into a lecturing mode. Lecturing tends to lull the patient into
passivity. Try engaging your patients by periodically giving them an opportunity
to ask questions or react to the information. Try pausing occasionally during
your presentation so your patient can digest what you’ve said. Pauses will also
allow you to psychologically attend to their nonverbal reactions. - Remember that cognitive content is always emotionally charged. Your patients
may have strong emotional reactions to certain factual information. Consequently,
it will take them some time to comprehend and digest the facts. It’s generally a
good idea to repeat important information. - Pay attention to patients’ defenses and conscious and unconscious motivations.
You should try to recognize, for example, when patients are intellectualizing
their situation and are making decisions without really understanding the long-
range emotional impact these decisions will have (Klitzman 2010 ). - Accommodate patient cultural differences. Patients vary in their cultural inter-
pretations of the causes and significance of genetic conditions (Lewis 2010 ;
Steinberg Warren n.d.). Try to determine their cultural beliefs and values, and
then frame your information within their cultural context. For example, Gammon
et al. ( 2011 ) studied Latina and non-Latina White women at increased risk for
hereditary breast and ovarian cancer. They found that both groups wished to
discuss family issues, they desired advice, and they wanted more specific infor-
mation about testing. Latina women, however, were less aware of the availability
of testing. The researchers also found that “Women with a personal history of
cancer most often mentioned wanting to discuss family issues, followed by per-
sonal advice, and specific information about the test, while women without a
cancer diagnosis most often mentioned personal advice, followed by information
about the test, and discussing family issues” (p. 625). They concluded that it is
important to consider both “cultural factors (e.g., ethnic background) and indi-
vidual differences (e.g., history of cancer) in determining the type of information
to focus on during genetic counseling” (p. 625). - Remember that you do not have to know every answer. Don’t be afraid to say, “I
don’t know.” Then find out and get back to your patient via phone and/or letter or
refer your patient to another professional, if necessary. It may be that no one
knows the answer to the patient’s question, but this is also important information
to convey.
7 Providing Information and Facilitating Patient Decision-Making