Case Preparation

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).

 

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