175the type, timing, and amount of information desired by a given patient (Roshanai
et al. 2012 ).
As with other aspects of genetic counseling, you can increase your effectiveness
in providing information by employing your skill set, specifically, contracting
(Chap. 6 ), attending behaviors (Chap. 3 ), effective use of questions (Chap. 5 ), and
empathy (Chaps. 4 and 8 ).
Through the process of contracting, a genetic counselor can assess a patient’s
information needs (what the patient wants to know, what questions the patient has)
and collaborate with a patient to set an agenda that combines the counselor’s agenda
(critical information the patient needs to know) with the patient’s needs and agenda.
The genetic counselor can use attending behaviors and questions to assess a patient’s
prior knowledge as well as other factors that may impact her or his ability to hear
and assimilate information, such as health literacy. In order to understand a patient’s
emotional response to the referral and to the information provided during a genetic
counseling encounter, the counselor can use empathy. Questions will help a coun-
selor assess a patient’s understanding of and response to the information (“Was that
what you were expecting to hear?” “What questions do you have?” “How are you
feeling about this information?”). As you gain experience, you will be able to use
these skills to tailor information to meet the needs of each individual patient. One
size does not fit all in providing information in genetic counseling.
Importantly, in most genetic counseling situations, there is critical information
that a genetic counselor must communicate about topics such as risks, testing
options, testing results, and medical management recommendations, regardless of
patient preference for discussing them. Presenting critical information in a way that
each patient can hear and use it is itself a skill. Every patient is different, and meet-
ing individual needs is the art of genetic counseling.
7.1.1 Providing Information vs. Giving Advice
Providing information, when done effectively, gives patients knowledge they can
use to choose their own course of action. Providing information differs from giving
advice, in that advice is an attempt to suggest what a patient should do. As discussed
in Chap. 10 , because genetic counseling is a medically based practice, there will be
times where giving advice is not only appropriate but the standard of care. There are
many circumstances when a genetic counselor would not hesitate to provide advice.
For example:
- Advising a patient with a BRCA mutation to have increased screening for breast
cancer - Advising a pregnant woman against consuming alcohol during the pregnancy
- Recommending that a patient share genetic risk information with at-risk
relatives - Encouraging the parents of a child with a genetic metabolic condition to follow
the recommended diet
7.1 Communicating Information