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

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problems” and move on with her plans to have additional pregnancies. Sue tells you
she does not agree with her sisters and that she believes “knowledge is power.” She
wants to learn as much as she can about Emily’s developmental problems in hopes
that this may lead to interventions which will be helpful to her. You notice that John
has been very quiet throughout this discussion and ask him directly what his thoughts
are about proceeding with the WES study. John responds that he will go along with
whatever Sue wants, but he is personally “worn out” by the multiple evaluations and
visits to doctors and developmental specialists. He tends to agree with Sue’s sisters
that they should go ahead with their plans to have more children and “hope for the
best.” Whole exome sequencing (WES) performed on a blood sample obtained from
Emily reveals nothing relevant to her developmental deficits, but it does reveal a
mutation in BRCA1. Should this result be shared with Sue and John?

Instructor Note

• Students can be asked to redo the grid for an alternative WES result which reveals
  a mutation in the PSEN1 gene (early-onset Alzheimer disease). Should this result
  be shared with Sue and John?


• You could use the students’ grids as the basis for an in-class activity in which
  they share their responses to the following questions: What option did each of
  you select? What is your rationale for selecting that option? After discussing
  their responses, students consider together which elements of the model explain
  the similarities, or differences, in their choices.


• Students should also discuss pre-counseling strategies that would be helpful in
  addressing situations such as these.

Exercise 4: Role-Play

Engage in a 20-min role-play of a genetic counseling session with a classmate. The
role-play can be based on a patient you saw in the clinic, or it can be a made-up
patient situation. Focus on an ethical dilemma that arises during the interaction.
Audio record the role-play. Next transcribe the role-play and critique your work.
Use the following method for transcribing the session:

Counselor Patient Self-critique Instructor

Key phrases of

dialogue

Key

phrases

Comment on your own

response

Will provide feedback on your

responses

Create a brief summary:

1. Briefly describe patient demographics (e.g., age, gender, ethnicity, socioeco-
   nomic status, relationship status), reason for seeking genetic counseling, and the
   nature of the ethical dilemma that arose.


2. Identify two things you said/did during the role play that were effective, and two
   things you could have done differently:
   Give the recording, transcript, and self-critique to the instructor who will provide
   feedback.

13.8 Written Exercises