Facilitating the Genetic Counseling Process Practice-Based Skills, Second Edition

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Decision

Proceed with genetic testing (alternative A) or do not have genetic testing (alterna-
tive B).

First List and Then Evaluate Each Factor

As shown in Table 7.1, the patient and counselor identified each relevant factor
and then indicated which factors would lead to alternative A or В by placing an
X in the column of the alternative most likely to satisfy or prevent each
factor.

Choose the Most Important Factors

Upon further discussion, the patient identified the factors that are most important to
her decision: Relief of knowing for sure and not wanting to pass gene mutation on
to future children.

Table 7.1 Example of Danish and D’Augelli (1983) rational decision-making model

Relevant factors

Alternative А

Have test

Alternative В

No test

Medical

Address risk, specifically, confirmation of PSEN1

mutation status

X –

There are no treatments available – X

Psychosocial

Desire to have more children – X

Not wanting to pass gene mutation on to future children X –

Anxiety about “not knowing” X –

Relief of knowing for sure X –

Possible impact of test results on marriage and other

relationships

• X

Financial

Ability to plan for future if test results positive X –

Concern about employment/insurance discrimination – X

Implications of positive results

Concern about ability to handle “positive” test result – X

Husband may not be willing to have another child – X

Fear about possibility of having passed gene on to her

daughter

• X

7 Providing Information and Facilitating Patient Decision-Making