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are deceased, and no genetic testing was performed. BRCA testing reveals a vari-
ant of unknown significance.
Estimated time: 60–90 min.Activity 11: Risk Information, Positive Test Results,
and Decision-Making Model
The instructor role-plays with a volunteer from class. The instructor demonstrates
how to (1) present risk information, (2) present positive test results, and (3) assist
patient with decision-making.
Process
After the role-play, students discuss their observations of the counselor’s behaviors
and their impact on the patient.
Estimated time: 45 min.
Activity 12: Decision-Making (Small Group Role-Plays)
The students form small groups (four to five students). In each small group,
either the instructor or a student pretends to be a genetic counseling patient. The
patient role-plays one of the following scenarios that involve patient
decisions:
- The prenatal patient states that she does not want to consider abortion as an
option before the genetic counselor has said anything about it. - The patient wants the genetic counselor to tell him what to do regarding whether
to have presymptomatic testing for Huntington disease. - The patient minimizes the increased risk for cancer when she carries the BRCA1
gene mutation. - The patient misunderstands the risk information given to her (she thinks having
a 25% chance of having a child affected with cystic fibrosis means that only one
of four of her children would be affected). - The 55-year-old patient with breast cancer with a negative family history greatly
overestimates her risk for having a gene mutation (90% when her risk is actually
5–10%). - The patient has a fetus with anencephaly. She is afraid of what her family will
think if she decides to terminate the pregnancy.
The role-plays can last 15–20 min. The counselor or instructor can stop a role-
play if the counselor gets stuck and discuss with the group how to proceed.
Estimated time: 90 min.
7 Providing Information and Facilitating Patient Decision-Making