Dissertation/Thesis Abstract

Making decisions about genetic testing: Understanding the process in prenatal and cancer genetic contexts
by Weaver, Meredith Alison, Ph.D., The Johns Hopkins University, 2010, 179; 3440757
Abstract (Summary)

The goal for the genetic counselor is to ensure that a client makes an informed decision about whether to pursue genetic testing. The current study seeks to better understand the process by which an analogue client responds to the cognitive, affective, and decisional demands when deciding whether to pursue genetic testing in the prenatal and cancer genetic counseling contexts.

This is a secondary analysis of data collected during the Genetic Counseling Video Project. Data for this study came from 559 analogue clients who watched a videotape of a genetic counseling session. The analogue clients' variables of interest were: knowledge, informational satisfaction, interpersonal satisfaction, increase in state anxiety, decisional conflict, trait anxiety, literacy, numeracy, and nonverbal sensitivity. Latent class analysis and multinomial regression analysis were used to explicate the relationships among the variables. Open-ended responses were analyzed for word patterns that would further explain the quantitative findings.

Three analogue client patterns of response emerged: engaged/resolved, engaged/unresolved, and unengaged/unresolved. The most common response was to engage in the counseling process and be resolved in regard to genetic testing. A larger percentage of the prenatal analogue clients than the cancer clients were unengaged, but the clients were equally split in regard to decisional resolve. Poor learning and being unengaged in regard to decision making was significantly associated with lower trait anxiety, being African American, and choosing to talk to someone else before making a decision. Analogue clients who were engaged but unresolved had one significant predictor: talking to someone else before making a decision Analysis of the open-ended responses supported the descriptions of the response patterns.

Genetic counselors may need to utilize experiential teaching techniques or alter the way they communicate to increase client learning. Acknowledging that actions and demeanor can affect the interaction between the genetic counselor and client may help improve client resolve. The findings for the unengaged/unresolved analogue clients revealed that some clients may need extra time or explanation in order to understand genetic information better. Future research can explore whether recognition of the three response patterns helps genetic counselors differentiate their clients and whether this distinction is useful.

Indexing (document details)
Advisor: Roter, Debra
School: The Johns Hopkins University
School Location: United States -- Maryland
Source: DAI-B 72/03, Dissertation Abstracts International
Subjects: Genetics, Public health
Keywords: Cancer genetic counseling, Client patterns, Genetic testing, Prenatal genetic counseling
Publication Number: 3440757
ISBN: 9781124426662
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