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when we were reviewing your family history, you mentioned how close you are
to your brother and sister. I wonder if it might help to think about what it would
do to your relationship if you don’t tell them, and then they get sick? I think it
would be good to tell them. Can we talk about how I can help you with this?”- Emphasize the decision-making process rather than the outcome. “You’ve asked
me if I think you should have carrier testing. From what you’ve said, these seem
to be some of the reasons you might make that decision, and these are some of
the reasons you might not...” This sort of response provides what Kessler ( 1997 )
refers to as a framework from which patients can view things more clearly. - Use primary empathy to reflect your understanding of your patient’s view of the
problem. For example, regarding a patient at risk for Huntington disease: “It
sounds like you would like to find a good way to talk to your children about your
risk [primary empathy]. Maybe a family counselor could help you find the right
time and way to discuss this with your children [advice]” (Kao 2010 , p. 101). - Give advice in language that is consistent with the patient’s view of the problem.
“You’ve said several times that you feel like you’re ‘being smothered’ with the
weight of this decision. What would you think about taking a couple of days to
catch your breath? Could you put down the weight for a little while before you
make your final decision?” - Be culturally sensitive. Patients differ in their desire for advice. Sometimes these
differences are due to cultural background. Two studies illustrate cultural differ-
ences in genetic counseling patients’ reactions to advice. Barragan et al. ( 2011 )
interviewed women of Mexican origin regarding how they balance cultural prac-
tices with Western medicine. They noted that Mexican women expect to receive
prescriptive medical advice and adhere to that advice. They found, however, that
“More traditional women depended heavily on the advice of their mothers or
other supportive women, while more acculturated women sought additional
information from healthcare providers and written brochures” (p. 610). The
authors also described a possible barrier to genetic counselors’ understanding of
patient reactions to advice, namely, simpatía or “the practice of demonstrating
respect to healthcare providers by not questioning them and giving the appear-
ance of understanding and agreeing with the provided advice even when this is
not the case” (p. 620). They recommended genetic counselors use open-ended
questions to assess patients’ comprehension and their intention to comply,
whether and how particular interventions may be potentially problematic, what
patients think or feel about specific medical recommendations, and how comfort-
able they are discussing information with family members.
Floyd et al. ( 2016 ) interviewed Spanish-speaking and English-speaking Latina,
Asian, and White women who had received prenatal care about their opinions of
cell-free DNA (cfDNA) screening. Among their results, they found more Spanish
speakers referenced their doctor’s advice as a reason to do prenatal testing as
they respected and thus would follow the advice. English speakers more often
critiqued the advice of care providers and more often disregarded the advice of
10 Providing Guidance: Advice andfiInfluencing Skills