293Forgetting that Patients Ultimately Are Responsible for Making Their Own
Decisions
When you provide advice, you risk shifting the responsibility for the outcome to
you, especially for patients who appear to be desperate for advice. Instead, try indi-
cating that you understand their need for advice and are willing to help them figure
out what’s best for themselves (Couture and Sutherland 2006 ; Martin 2000 ). For
instance, “I know you feel like you can’t make this decision alone. Why don’t we
try together to figure out the best way to proceed?”; or with a patient affected with
Long QT who wants to have a baby (which is life threatening for her), “... What we
can do is talk about all of the possibilities and options that are available to you, to
help you make the right decision for you” (Kao 2010 , p. 85).
Thinking Your Behavior Is Advice-Free
Patients who want advice will believe you’ve given it even when you thought you
were trying to support their autonomy. Be watchful for clues that patients are trying
to pull a recommendation from you (e.g., patient says, “You probably think this is a
bad idea...”; or “I suppose you think I’m making a mistake...” Think carefully about
how you want to respond to such statements).
10.2 Influencing Responses
Influencing responses are expressions of the genetic counselor’s opinion about the
patient and/or topics relevant to genetic counseling processes and outcomes (e.g.,
the patient’s feelings, thoughts, attitudes, actions, situation, plans, etc.). Some
influencing statements express agreement/support, and, as such, they positively
reinforce the patient (e.g., “Your decision seems to be well-thought out” or “You’re
going to get through this”). Other influencing statements express disagreement,
and, as such, they provide a cautionary note to the patient (e.g., “Your decision
seems a bit rushed” or, to the father in a prenatal session, “You say that this deci-
sion is up to your wife, but really, she is looking for your support”). Influencing
responses are a form of persuasion as they are attempts either to affirm patients’
feelings, attitudes, and behaviors or to modify them. Synonyms for influence are
effect, inspire, impact, encourage, sway, manipulate, persuade, induce, prompt,
and impel.
Often influencing responses are intended to provide encouragement to patients.
Wong ( 2015 ) argues that “Encouragement is one of the most common ways through
which individuals express support for one another...” (p. 179). He defines encour-
agement as: “the expression of affirmation through language or other symbolic rep-
resentations to instill courage, perseverance, confidence, inspiration, or hope in a
10.2 Influencing Responses