Psychosocial Assessment, Support and Counseling

Facilitating Decision Making

The genetic counselor’s role often involves helping clients and their families discuss and make decisions related to testing, treatment, and reproduction. Developing rapport and trust, and gaining an understanding of their specific cultural beliefs and values promotes the counselor’s ability to engage in shared decision making with clients. With this approach, patients are not “abandoned” to decipher on their own the substance and relevance of clinical information. This information, along with the lived experiences of the client, places the professional and the client on more equal footing (Hunt, de Voogd, & Castaneda, 2005). Hunt (2005) states that a shared decision making approach “provides an opportunity to go beyond simply presenting relevant facts in a value-free way, and to actively contribute to the decision-making process, without forsaking the principle of nondirectiveness.”

Exercise

List 5 “decisions” made by clients in your presence in the last week. In each of these cases, think about your role in facilitating the clients’ decisions. What questioning and counseling strategies did you use? What “decisions” are relevant to this case?

Cultural mnemonic tools such as LEARN can be helpful for thinking through and implementing the process of decision making in genetic counseling. Consider how the genetic counselor could use this tool to explore and facilitate decisions of relevance to this case.

LEARN:

Listen with sympathy and understanding to the patient's perception of the problem.

Explain your perceptions of the problem and your strategy for treatment.

Acknowledge and discuss the differences and similarities between these perceptions.

Recommend treatment while remembering the patient's cultural parameters.

Negotiate agreement. It is important to understand the patient's explanatory model so that medical treatment fits in their cultural framework.

       Source: Berlin & Fowkes, 1983

 

 

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