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and have demonstrated accurate empathy (Feng 2009 ; Goldsmith and Fitch
1997 ; Hepburn and Potter 2011 ). It’s important to assess what patients are
thinking of doing and why (e.g., “Who is your family would be understanding of
your decision to have testing?” This question could help you assess the extent to
which the patient might be able to seek emotional support from family
members).
- Wait until asked. Sometimes patients will ask you directly for advice (e.g., “How
can I approach my family members about cascade testing?”). They may more
readily accept your advice when they ask you for it. At times, however, you may
need to approach a topic regardless of whether a patient has directly asked for
advice.
- Offer advice gently. Avoid getting into arguments with patients. If patients resist,
do not try to “argue [them] into backing down and accepting what you say”
(Martin 2000 , p. 63). Arguing is almost never effective for influencing patients to
follow a suggested course of action. Instead, they will shut down, pretend to
agree, leave prematurely, etc.
- Mention decisions made by other patients. Sometimes it’s helpful to briefly and
anonymously describe what other patients in similar situations have done (e.g.,
“Many people find it helpful to discuss their testing options with their close rela-
tives before making a final decision”).
- Embed your advice. Insert your advice within information provision (Hepburn
and Potter 2011 ) (e.g., “I’d like to discuss our recommendations for sharing your
test results with your close relatives, and share some strategies that other patients
have used for doing this.”).
- Check out the impact of your advice. Ask patients to discuss what they think and
feel about your recommendations. This assessment also helps to ensure they
accurately understood your advice.
- Use questions instead of advice to facilitate decisions. Use questions that get at
what the patient considers to be the pros and cons of different options rather than
suggesting what the patient should do. For example, you might say, “Which deci-
sion do you think you would feel more comfortable making?” Your questions
will assist patients in thinking through their decision-making process to arrive at
an outcome that is best for them rather than directing them to do what you think
is best.
- Use questions and advanced empathy to set the stage for advice. Vehvilainen
( 2001 ) describes a stepwise entry method for advice giving through a question-
answer format designed to align the advice with the patient’s perspective and to
minimize resistance. In this approach, the counselor first asks the patient what
she/he is thinking of doing. The patient’s answer to this question “...can be used
as grounds for the counselor’s advice, but the counselor can focus on the short-
comings of the [patient’s] ideas and provide a revised plan” (p. 396). Consider
this example. A patient with heart disease finds out she has a gene mutation that
is responsible for her condition. When the genetic counselor asks if she plans to
share these results with her brother and sister, the patient says “No, I don’t want
to worry them.” The genetic counselor may then reply, “Earlier in the session,
10.1 Advice Giving
