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7.1.4 Strategies for Communicating Positive Test Results
Prepare in Advance
- Make a plan with the patient about how you will provide the testing results.
Check to see what phone number to use, with whom you can communicate, and
whether it is acceptable to leave a message. If results are only given in person,
when is the follow-up visit, and what will happen at that visit? Will you com-
municate with the patient’s primary care provider? Having a plan will help you
maintain the patient’s privacy in a way that is of their choosing, and it will allevi-
ate some of the anxiety that is natural while waiting for test results. - Practice giving positive results with a colleague so you know what you want to
say and how you want to say it. Be genuine when providing results, and be pre-
pared for strong emotions in the patient. Remember that you might react to those
emotions as well. - For a given patient, visualize the meeting in which you present the results. Try to
imagine in detail what each of you will say, feel, and do. - When you are unfamiliar with the cultural values and practices of your patient,
research how positive test results are best communicated. You could, for
instance, consult with experienced medical interpreters and review relevant lit-
erature. Cultural variables can affect the way in which genetic counselors pro-
vide information. For example, Jecker et al. ( 1995 ) described a case in which
possible bad outcomes were communicated to a Navajo patient by referring to
a hypothetical third party; this was done to reduce the patient’s likelihood of
thinking he was “being witched.” For some patients from Middle Eastern cul-
tures, the family is a paramount resource for coping during times of crisis such
as illness, and efforts may be made to shield vulnerable family members from
unwelcome news (Awwad et al. 2008 ; Lipson and Meleis 1983 ). Therefore, a
male family member (father or grandfather) may take the lead in the genetic
counseling session. - Help the patient to prepare in advance by using anticipatory guidance. You could
ask patients to engage in scenarios prior to undergoing testing. As we mentioned
earlier, it may be helpful to prepare people to receive results prior to testing by
discussing all possible test outcomes (Semaka et al. 2013 ). Ask them to imagine
and describe what they will feel, think, and do if the results are positive, negative,
or a variant of uncertain significance (VUS). In addition to helping patients antic-
ipate their reaction, this strategy gives you some idea of how they may react
when you present them with the test results.
Deliver the News
- Proceed slowly and calmly. Patients need time to absorb this type of news, and
they will be more likely to express their feelings if you take a low-key
approach.
7 Providing Information and Facilitating Patient Decision-Making