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Motivational interviewing for genetic counseling: A unified framework for persuasive and equipoise conversations.

Authors :
Resnicow K
Delacroix E
Chen G
Austin S
Stoffel E
Hanson EN
Gerido LH
Kaphingst KA
Yashar BM
Marvin M
Griggs JJ
Cragun D
Source :
Journal of genetic counseling [J Genet Couns] 2022 Oct; Vol. 31 (5), pp. 1020-1031. Date of Electronic Publication: 2022 Jul 30.
Publication Year :
2022

Abstract

Genetic counselors (GCs) have traditionally been trained to adopt a position of equipoise or clinical neutrality. They provide information, answer questions, address barriers, and engage in shared decision-making, but generally, they do not prescribe a genetic test. Historically, GCs have generally been trained not to persuade the ambivalent or resistant patient. More recently, however, there has been discussion regarding when a greater degree of persuasion or directionality may be appropriate within genetic counseling (GC) and what role MI may play in this process. The role for "persuasive GC" is based on the premise that some genetic tests provide actionable information that would clearly benefit patients and families by impacting treatment or surveillance. For other tests, the benefits are less clear as they do not directly impact patient care or the benefits may be more subjective in nature, driven by patient values or psychological needs. For the former, we propose that GCs may adopt a more persuasive clinical approach while for the latter, a more traditional equipoise stance may be more appropriate. We suggest that motivational interviewing (MI) could serve as a unifying counseling model that allows GCs to handle both persuasive and equipoise encounters. For clearly beneficial tests, while directional, the MI encounter can still be non-directive, autonomy-supportive, and patient-centered. MI can also be adapted for equipoise situations, for example, placing less emphasis on eliciting and strengthening change talk as that is more a behavior change strategy than a shared decision-making strategy. The core principles and strategies of MI, such as autonomy support, evocation, open questions, reflective listening, and affirmation would apply to both persuasive and equipoise encounters. Key issues that merit discussion include how best to train GCs both during their initial and post-graduate education.<br /> (© 2022 The Authors. Journal of Genetic Counseling published by Wiley Periodicals LLC on behalf of National Society of Genetic Counselors.)

Details

Language :
English
ISSN :
1573-3599
Volume :
31
Issue :
5
Database :
MEDLINE
Journal :
Journal of genetic counseling
Publication Type :
Academic Journal
Accession number :
35906848
Full Text :
https://doi.org/10.1002/jgc4.1609