Components of the Genetic Counseling Session
Consider the relative importance of discussing these points with Mary during her genetic counseling session. Note yes or no as appropriate if you would include these components in the session. Which component is most important to include? Which component is least important to include?
___ Set goals and perform contracting at the outset of the appointment
___ Review Mary’s medical history and her pregnancy history
___ Determine who the father of the baby is (for genetic or other reasons)
___ Take a complete pedigree
___ Review genetic causes for developmental disabilities
___ Talk about recurrence risks
___ Talk about Mary’s reproductive options in terms of screening and diagnosis
___ Talk about Mary’s psychosocial situation including her feelings about her pregnancy
___ Explore Mary’s past decision-making processes
___ Connect Mary with community resources
Although a genetic counselor’s instinct may be to conduct a comprehensive genetic counseling session with Mary, there are several barriers to taking this approach. Mary may be an unreliable historian, so generating a complete pedigree may be too difficult to accomplish during the session. The family history could be done, with Mary’s consent, by talking with a support person before the session. Discussing risks and inheritance patterns may be too abstract for Mary to understand, so your time with Mary may be better spent discussing psychosocial concerns. Because she may have had little or no past experience making her own decisions, it may be more useful to focus on Mary’s current beliefs and helping her formulate future plans. Empowering care and effective communication will focus on a woman’s abilities rather than on her disabilities (Smeltzer, 2007).