115Family history taking is also a good way to begin to establish rapport with a patient.
There are several process functions of taking a pedigree:
- Pedigree taking can foster counselor empathy and lead to greater rapport between
the genetic counselor and patient(s) (Bennett 2010 ; Erlanger 1990 ; Schuette and
Bennett 2009 ). - Constructing a pedigree puts the patient in the role of expert and the counselor in
a one-down position; this can be especially important if patients feel out of con-
trol of their situations or are mistrustful of health-care professionals (Erlanger
1990 ). Patients may be more likely to view themselves as active participants in
the etiology and management of their conditions (Stanion et al. 1997 ). - Some research suggests patients view pedigree construction positively; for
instance, they like to provide information, it makes them feel listened to, and the
process eases their anxiety (Erlanger 1990 ; Rose et al. 1999 ). - Pedigree construction can help patients who are uncomfortable with open-ended
questions to respond because questions are asked in a more systematic, matter-
of- fact way (Paradopoulos et al. 1997 ). - The pedigree provides a mechanism for considering information about patient
risk and serves as a stimulus for discussing genetic risks, relevant tests, and fur-
ther actions (Bennett 2010 ; Rose et al. 1999 ; Schuette and Bennett 2009 ). - A pedigree provides an immediate illustration of the family’s medical history
that can be more easily updated, and important information can later be located
more easily as compared to a narrative report (Paradopoulos et al. 1997 ; Stanion
et al. 1997 ).
Questions to Meet Genetic Counseling Goals
Research shows that genetic counselors use questions to achieve the Reciprocal-
Engagement Model (REM) goals associated with promoting understanding and
appreciation of the patient, providing support and guidance, facilitating decision-
making, and providing patient-centered education (Redlinger-Grosse et al. 2017 ).
Examples include open-ended and closed-ended questions about how much infor-
mation patients would like and their prior knowledge, emotional impact of genetic
information, anticipated feelings about information, patients’ communication with
family members, family members’ decision-making and reaction to crisis, cultural
context in decision-making, patients’ support persons and experience with crisis
situations, and impact of options on family.
Miranda et al. ( 2016 ) interviewed a sample of master genetic counselors and
found all but one described the importance of “attunement to their patients’ emo-
tions” (p. 772). They achieved this attunement “by using intuitive and perceptive
skills (e.g., ‘There’s this internal dialogue: What else is going on here? What do I
need to do to get to that place with them?’), life experience, immediacy, and strate-
gic questioning [emphasis ours] to connect and provide an opening for emotional
5.1 Obtaining Information from Patients