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Spector A, Ash E, Garland B, McLaughlin R, Ritenour A, Gonynor C, Riconda D. Perceptions of motivational interviewing in genetic counseling practice and training. J Genet Couns 2022; 31:1173-1182. [PMID: 35502606 DOI: 10.1002/jgc4.1588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 04/18/2022] [Accepted: 04/25/2022] [Indexed: 11/11/2022]
Abstract
Motivational interviewing (MI) is a counseling approach that allows a provider to engage in a dialog with patients to evoke motivation for health behavior change or decision-making. MI is a relatively recent addition to the curricula of genetic counseling programs, and recent research has demonstrated its utility in genetic counseling practice. However, the perspectives of genetic counselors trained in MI have yet to be studied with the intent of illuminating how it is applied in practice or what should be emphasized in training. This qualitative study interviewed fifteen genetic counselors from various practice areas who have had training in MI. The interviews focused on how MI is being used in practice, and the strengths and weaknesses of their MI training. Five themes were identified through inductive qualitative analysis: (a) utility of MI in genetic counseling practice, (b) value of MI in genetic counseling training, (c) barriers to implementing MI in genetic counseling practice, (d) barriers to training genetic counselors in MI, and (e) timing of MI training. The perspectives discovered from this study can help inform genetic counseling educators who wish to include MI in their curriculum. In addition for those programs that already include MI, these results serve as a guide for the development of training role-plays and/or standardized patient encounter scenarios.
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Affiliation(s)
- Ashley Spector
- School of Health Professions, Baylor College of Medicine, Houston, Texas, USA.,Sarah Lawrence College, Joan H. Marks Graduate Program in Human Genetics, Bronxville, New York, USA
| | - Erin Ash
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Beth Garland
- Psychological and Brain Sciences, Texas A&M University, College Station, Texas, USA
| | - Robert McLaughlin
- School of Health Professions, Baylor College of Medicine, Houston, Texas, USA
| | - Adasia Ritenour
- School of Health Professions, Baylor College of Medicine, Houston, Texas, USA.,Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA
| | - Caroline Gonynor
- Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington, USA
| | - Daniel Riconda
- School of Health Professions, Baylor College of Medicine, Houston, Texas, USA.,Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA
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2
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Winchester B, Cragun D, Redlinger-Grosse K, Walters ST, Ash E, Baldry E, Zierhut H. Application of motivational interviewing strategies with the extended parallel process model to improve risk communication for parents of children with familial hypercholesterolemia. J Genet Couns 2022; 31:847-859. [PMID: 35150174 DOI: 10.1002/jgc4.1554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 01/10/2021] [Accepted: 01/14/2021] [Indexed: 12/30/2022]
Abstract
Current genetic counseling practice has not been found to significantly increase risk communication between family members. A more diverse set of genetic counseling approaches may be needed. A genetic counseling intervention based on motivational interviewing principles and the extended parallel process model was utilized to increase cascade outcomes within families with familial hypercholesterolemia, a common, underdiagnosed, and treatable condition. Parents of children with familial hypercholesterolemia were invited to participate in an online pre-survey, single-session genetic counseling intervention, and post-intervention surveys as a part of the CHEERS (Cholesterol Evaluation to Explore Risk Screening) intervention. This study investigated the efficacy of a genetic counselor delivered motivational interviewing intervention and how parents of children with familial hypercholesterolemia react by assessing family member cholesterol screening and risk communication to at-risk relatives. Transcripts were audio-recorded, transcribed, and analyzed for change talk using the Motivational Interviewing Skill Code version 2.1. Participant surveys were analyzed for self-reported extended parallel process constructs and motivations. Coincidence analysis was conducted to explore differences between those with and without positive cascade outcomes within 12 months after the intervention. On average, change talk increased during the session in order of the extended parallel process constructs (perceived severity, susceptibility, response efficacy, self-efficacy). Coincidence analysis revealed that 6 of the 7 cases with positive cascade outcomes were explained by either the presence of high change talk during the intervention or presence of positive motivations shortly after, while 5 of the 5 cases without a positive outcome lacked both of these key factors that were associated with cascade outcomes. Results of this study suggest that incorporating motivational interviewing and the extended parallel process model increases change talk and that the presence of either high levels of change talk or positive motivations is associated with positive cascade outcomes.
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Affiliation(s)
- Bridget Winchester
- Department of Genetics, Cell Biology, & Development, University of Minnesota-Twin Cities, Minneapolis, Minnesota, USA
| | - Deborah Cragun
- College of Public Health, University of South Florida, Tampa, Florida, USA
| | - Krista Redlinger-Grosse
- Department of Genetics, Cell Biology, & Development, University of Minnesota-Twin Cities, Minneapolis, Minnesota, USA
| | - Scott T Walters
- School of Public Health, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Erin Ash
- Genetic Counseling Program, Sarah Lawrence College, Bronxville, New York, USA
| | - Emma Baldry
- Department of Genetics, Cell Biology, & Development, University of Minnesota-Twin Cities, Minneapolis, Minnesota, USA
| | - Heather Zierhut
- Department of Genetics, Cell Biology, & Development, University of Minnesota-Twin Cities, Minneapolis, Minnesota, USA
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3
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Baldry E, Redlinger-Grosse K, MacFarlane I, Walters ST, Ash E, Steinberger J, Murdy K, Cragun D, Allen-Tice C, Zierhut H. Outcomes from a pilot genetic counseling intervention using motivational interviewing and the extended parallel process model to increase cascade cholesterol screening. J Genet Couns 2021; 31:164-175. [PMID: 34260792 DOI: 10.1002/jgc4.1466] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 06/01/2021] [Accepted: 06/14/2021] [Indexed: 12/26/2022]
Abstract
Familial hypercholesterolemia (FH) is an inherited condition resulting in increased risk of premature cardiovascular disease. This risk can be reduced with early diagnosis and treatment, but it can be challenging to identify individuals with FH. Cascade screening, the most efficient and cost-effective identification method, requires FH patients to communicate with their at-risk family and encourage them to pursue screening. Beyond FH, patients with conditions increasing disease risk to family members report barriers to the communication process such as insufficient knowledge of the condition and discomfort informing relatives. We conducted a pilot study of a genetic counseling intervention incorporating behavior-change principles from motivational interviewing (MI) and the extended parallel process model (EPPM) to help parents of children with FH overcome these barriers and improve cascade screening rates for FH. Of the 13 participants who completed the intervention and post-intervention surveys, 6 reported contacting and/or screening additional relatives. A large effect size in increasing communication and screening was observed (η2 = 0.20), with the mean percent of at-risk relatives contacted rising from 33% to 45%, and the mean percent screened rising from 32% to 42%. On average, 2.23 new relatives were contacted and 2.46 were screened, per participant, by the end of the study. Direct content analysis revealed that despite the open-ended nature of the goal-setting process, participant goals fell into two categories including those who set goals focused on communicating with and screening family members (n = 9) and those who set goals only focused on managing FH (n = 4). Overall, the communication and screening rates reported after the intervention were higher than previous observations in adult FH populations. These results suggest this EPPM/MI genetic counseling intervention could be a useful tool for increasing communication and cascade screening for FH. With further research on goal-setting techniques, the intervention could be refined and replicated to identify more individuals affected by FH or modified for use with other actionable genetic conditions.
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Affiliation(s)
- Emma Baldry
- Department of Genetics, Cell Biology, and Development, University of Minnesota, Minneapolis, MN, USA
| | - Krista Redlinger-Grosse
- Department of Genetics, Cell Biology, and Development, University of Minnesota, Minneapolis, MN, USA
| | - Ian MacFarlane
- Department of Genetics, Cell Biology, and Development, University of Minnesota, Minneapolis, MN, USA
| | - Scott T Walters
- Health Sciences Center, University of North Texas, Fort Worth, TX, USA
| | - Erin Ash
- Sarah Lawrence College, Broxville, NY, USA
| | - Julia Steinberger
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Kari Murdy
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Deborah Cragun
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Carly Allen-Tice
- Department of Genetics, Cell Biology, and Development, University of Minnesota, Minneapolis, MN, USA
| | - Heather Zierhut
- Department of Genetics, Cell Biology, and Development, University of Minnesota, Minneapolis, MN, USA
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4
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Abstract
Cardiovascular genetic counselors provide guidance to people facing the reality or prospect of inherited cardiovascular conditions. Key activities in this role include discussing clinical cardiac screening for at-risk family members and offering genetic testing. Psychological factors often influence whether patients choose to have genetic testing and how they understand and communicate the results to at-risk relatives, so psychological counseling increases the impact of genetic education and medical recommendations. This work reviews the literature on the factors that influence patient decisions about cardiovascular genetic testing and the psychological impact of results on people who opt to test. It also models use of a psychological framework to apply themes from the literature to routine cardiovascular genetic counseling practice. Modifications of the framework are provided to show how it can be adapted to serve the needs of both new and experienced genetic counselors.
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Affiliation(s)
- Julia Platt
- Stanford Center for Inherited Cardiovascular Disease, Falk Cardiovascular Research Center, Stanford, California 94305, USA
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5
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Kruger V, Redlinger‐Grosse K, Walters ST, Ash E, Cragun D, McCarthy Veach P, Zierhut HA. Development of a motivational interviewing genetic counseling intervention to increase cascade cholesterol screening in families of children with familial hypercholesterolemia. J Genet Couns 2019; 28:1059-1064. [DOI: 10.1002/jgc4.1145] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Valerie Kruger
- Department of Genetics, Cell Biology, and Development University of Minnesota—Twin Cities Minneapolis Minnesota
| | - Krista Redlinger‐Grosse
- Department of Genetics, Cell Biology, and Development University of Minnesota—Twin Cities Minneapolis Minnesota
| | - Scott T. Walters
- School of Public Health University of North Texas Health Science Center Fort Worth Texas
| | - Erin Ash
- Genetic Counseling Program Sarah Lawrence College Broxville New York
| | - Deborah Cragun
- College of Public Health University of South Florida Tampa Florida
| | - Patricia McCarthy Veach
- Department of Genetics, Cell Biology, and Development University of Minnesota—Twin Cities Minneapolis Minnesota
| | - Heather A. Zierhut
- Department of Genetics, Cell Biology, and Development University of Minnesota—Twin Cities Minneapolis Minnesota
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Costa C, Lemos MS, Paneque M. The Contribution of the Reciprocal-Engagement Model as a Theoretical Framework of a Portuguese Scale for Quality Assessment of Genetic Counseling. J Genet Couns 2018; 27:1005-1007. [DOI: 10.1007/s10897-018-0275-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 06/18/2018] [Indexed: 10/28/2022]
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Bamshad MJ, Magoulas PL, Dent KM. Genetic counselors on the frontline of precision health. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2018; 178:5-9. [PMID: 29582554 DOI: 10.1002/ajmg.c.31610] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 03/04/2018] [Indexed: 12/16/2022]
Abstract
By enabling precise genetic diagnosis and treatment there is great potential for inexpensive, accurate, and widely accessible genomic information to transform health care and improve the general well-being of virtually every person. To maximize this potential, approaches to genetic counseling and the role of genetic counselors will need to adapt to fit changing clinical and commercial needs worldwide. This will require overcoming multiple challenges including an inadequate workforce; development and implementation of alternate models of service delivery; integration of new technologies to improve, extend, and expand services; and support for equitable education and counseling among all populations. Genetic counselors are aptly poised to take on these challenges. The result will be better informed patients and families more capable of utilizing genetic information appropriately, making autonomous decisions about their care, and modifying their approach to disease risk to actively contribute to their health. The contributors to this issue of Seminars discuss how key areas of genetic counseling need to evolve and how genetic counselors can play a role in shaping the future of precision health.
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Affiliation(s)
- Michael J Bamshad
- Department of Pediatrics, University of Washington, Seattle, Washington.,Department of Genome Sciences, University of Washington, Seattle, Washington.,Division of Genetic Medicine, Seattle Children's Hospital, Seattle, Washington
| | - Pilar L Magoulas
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas.,Texas Children's Hospital, Houston, Texas
| | - Karin M Dent
- Department of Pediatrics, University of Utah, Salt Lake City, Utah
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Wicklund CAL, Duquette DA, Swanson AL. Clinical genetic counselors: An asset in the era of precision medicine. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2018; 178:63-67. [DOI: 10.1002/ajmg.c.31605] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 02/15/2018] [Accepted: 02/16/2018] [Indexed: 01/01/2023]
Affiliation(s)
- Catherine A. L. Wicklund
- Graduate Program in Genetic Counseling, Department of Obstetrics and GynecologyNorthwestern University Feinberg School of MedicineChicago Illinois
| | - Debra A. Duquette
- Graduate Program in Genetic Counseling, Department of CardiologyNorthwestern University Feinberg School of MedicineChicago Illinois
| | - Amy L. Swanson
- Graduate Program in Genetic Counseling, Department of Obstetrics and GynecologyNorthwestern University Feinberg School of MedicineChicago Illinois
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9
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Riconda D, Grubs RE, Campion MW, Cragun D. Genetic counselor training for the next generation: Where do we go from here? AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2018. [DOI: 10.1002/ajmg.c.31598] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Daniel Riconda
- Department of Molecular and Human GeneticsBaylor College of MedicineHouston Texas
| | - Robin E. Grubs
- Department of Human GeneticsUniversity of PittsburghPittsburgh Pennsylvania
| | - MaryAnn W. Campion
- Department of Genetics, Stanford Children's Health
- Lucile Packard Children's HospitalStanford University School of MedicineStanford California
| | - Deborah Cragun
- Department of Global Health, College of Public HealthUniversity of South FloridaTampa Florida
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10
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Djurdjinovic L, Peters JA. Special Issue Introduction: Dealing with Psychological and Social Complexity in Genetic Counseling. J Genet Couns 2017; 26:1-4. [PMID: 28271394 DOI: 10.1007/s10897-017-0080-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 02/06/2017] [Indexed: 10/20/2022]
Affiliation(s)
| | - June A Peters
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, 9609 Medical Center Drive, # 6E548, Rockville, MD, 20850, USA
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