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patient’s situation is conveyed, patient autonomy is supported, patient emotions are
addressed, and the patient is better able to cope. The process of genetic counseling
is channeled through this relationship. The REM clarifies that basic helping skills
described in this book are the tools necessary to forming this critical relationship,
without which genetic counseling goals cannot be achieved.
2.2.2 Research on the REM Goals and Outcomes
Hartmann et al. ( 2015 ) surveyed practicing genetic counselors and asked them to
rate each of the 17 REM goals in terms of their importance to their practice and how
often they were able to achieve the goal. All 17 REM goals were rated on average as
somewhat to very important. The analysis identified four factors that accounted for
variance in importance ratings. The authors noted that the five REM tenets could
apply to more than one factor. The 17 REM goals with corresponding factors are
shown in Table 2.2. The four factors are as follows:
- Understanding and Appreciation: This factor includes six goals emphasizing
counselor and patient awareness of how patients’ situations and characteristics
may influence their decision-making or feelings about a diagnosis or risk. Many
of the goals in this factor correspond to REM tenets Patients are resilient and
Patient emotions make a difference. - Support and Guidance: This factor includes six goals emphasizing development
of a supportive genetic counselor/patient relationship. The goals imply that the
counselor works with patients in ways that allow patients to feel involved, auton-
omous, and efficacious. These goals correspond to REM tenets Patient autonomy
must be supported, Patients are resilient, and Relationship is integral to genetic
counseling. - Facilitative Decision-Making: This factor includes three goals with some of the
highest importance ratings. These goals focus on informed, collaborative deci-
sions, and they correspond to REM tenets Patient autonomy must be supported
and Information is key. - Patient-Centered Education: This factor includes two goals involving counselor
presentation of genetic information in a way that patients can understand and
having good communication. These goals correspond to REM tenets Genetic
information is key and Relationship is integral to genetic counseling.
Building on the work of Hartmann et al. ( 2015 ), other researchers (Redlinger-
Grosse et al. 2016 ) have explored the relationships between REM goals and measur-
able genetic counseling outcomes. Starting with a REM goal, it is possible to
identify the desired outcome, which in turn can be measured. For example, for the
REM goal “patient is informed,” which falls within Factor 3 (facilitative decision-
making), Redlinger-Grosse et al. ( 2016 ) identified six possible measurable out-
comes: (1) change in communication regarding genetic information within the
patient’s family; (2) change in patient’s ability to ask appropriate questions regarding
2 Overview offiGenetic Counseling