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conversation” (p. 772). Note, their use of questions includes internal ones that you
should ask yourself, while others are questions you would ask patients.
Ellington et al. ( 2005 ) content analyzed 167 cancer genetic counseling pretest
sessions conducted by one of three genetic counselors. They found that the sessions
included “both closed and open-ended questions of any nature (e.g., medical, psy-
chosocial, and family history)” (p. 379). The genetic counseling sessions ranged in
length from about 73–81 min, and the number of questions counselors asked ranged
from 9 to 206 (mean = 84). The researchers concluded, “Despite counselors devot-
ing the major portion of the sessions to presenting information, the number of ques-
tions the counselors asked...indicates that they were also eliciting a substantial
amount of information” (p. 383).
Questions that Encourage Reflection
Sarangi et al. ( 2004 ) studied genetic counselors’ use of reflective frames with
patients during Huntington disease (HD) counseling sessions. They defined reflec-
tive frames as “exploring the psychosocial and the social relational dimension of
decision making about predictive testing and its future implications” (p. 137).
Reflective frames invite patients “...to offer a display of their understanding of the
decision-making procedure as well as their readiness to adjust to favorable, unfavor-
able, or indeterminate results arising out of testing. From the genetic counseling
perspective, clients need to think through the intended and unintended consequences
of having a test and do so in the clinical context of ‘here and now’” (p. 138). They
identified six types of reflective questions that occurred across initial and second
appointments with patients (pp. 141–142):
- Nonspecific invites—open-ended questions that invite patients to describe their
agenda and to raise any issues of concern (e.g., “When you came here today,
what were the issues you wanted to raise?”). - Awareness and anxiety—questions that explore patients’ and their family mem-
bers’ experiences of living at risk (e.g., “How much do you worry about HD?”
“What is your intuition about your HD status?”). - Decisions about testing—questions that explore how they reached their testing
decision and their primary motivations, whether timing of the decision is right,
and how other family members feel about the patients’ decision to have the test
(e.g., “What has made you think about having the test now?”). - Impact of result—questions assessing patients’ coping strategies and conse-
quences for them and their family members if the result is positive or negative
(e.g., “How do you think you would deal with knowing...?”). - Dissemination—questions that explore who the patient may wish to tell, when,
and how (e.g., “Who do you think you will tell?” “How will you go about telling
them?”).
5 Gathering Information: Asking Questions