If for example, you encountered a client with G6PD deficiency or Hereditary Breast and Ovarian Cancer Syndrome (HBOC), what could be the genetic information that are important to impart to the client? How can the genetic counselor-client relationship be strengthened?
In genetic counseling, communication is key and consists of facilitating understanding but this should not be a didactic-type of learning. One must also facilitate patient active involvement, relationship-building and eliciting patient concerns. In the article by Veach (Coming Full Circle: A Reciprocal-Engagement Model of Genetic Counseling Practice), it stresses how knowledge is power and how being informed is better than being uninformed. One of the reasons why patients seek out genetic counselors is to gain genetic information. We, as genetic counselors, should know what is important to impart and how to impart the knowledge in a way that would be useful and relevant to the patient.
If I encountered a client with Hereditary Breast Ovarian Cancer (HBOC) Syndrome, I would first collect genetic information that would be helpful for me to study and analyze the patient's comprehensive family history and estimate the patient's risk. Important things to impart and discuss with the patients are: the appropriate genetic testing to consider, analysis of the patient risk along with the cancer risk of different organs when you test positive for the BRCA1/ BRCA 2 gene, and medical management options available for patients. Important talking points are: possible prophylactic surgery (although still very controversial), hormone replacement therapy (if surgery pushes through), genetic and cancer research advancement, epidemiology of cancer.
As in handling any patient, genetic counselors must develop a patient-counselor relationship bond that will be key in communicating regarding patient illness. Listening to the patient attentively and not interjecting our thoughts might help in building a relationship. The patient should feel that he/she is being listened to and should believe that he/she has an advocate who will be concerned with his best interest. The psychosocial issues should be explored ethically. We should understand the importance of connection with the patient during one of the most trying times for the him/ her. We should foster the feeling of the patient that he/ she has support from us and that she is being cared for. We should develop in us, however, an objectivity to a maximal extent and allow opportunities for feedback/ critiquing. At the end, of the session, we may ask the patient what was learned and let him/her enumerate his key takeaway points that was taken from the session.
How can the client's autonomy be supported? How can we ensure resilience of our clients?
We should be allowing patient to have autonomy to be able to decide on his own. Counseling flexibility is to be maintained. Both counselor and client should have a parallel goal in mind to before starting the counseling. Since it is assumed that the counselor already built a relationship with the patient, the choice of what to discuss should be given to the patient. Then counselors should discuss it properly. Listening to the client intently and respecting their viewpoints are very important. The client's familial, cultural, psychosocial, emotional context should be understood and valued. At the same time, if there are misconceptions on theories that he has, it is our obligation to educate and guide them without sounding condescending. I believe having an honest interaction with the patient will help in building autonomy. A written note of all that was discussed with the patient, even the order of discussion may be helpful for future consultations. At the end, after presenting options, it is a must to let the patient sign an informed consent.
Ensuring patient resilience acknowledges patients have innate strengths and capabilities to withstand what they are currently going through. This is their "fight" mode which carries them through difficult situations that they would be able to surpass. Giving appropriate and adequate information on their condition and providing psychosocial and emotional support, patients can rise above what they are facing. Counselors should view the patients as not a subordinate but an equal who has the capacity to understand what is being discussed and independence to choose an option/ management. By letting patients know they have support and someone is looking out for them, they will have the strength to face discussion genetic risks. The patient should feel empowered after talking with the counselor. Identifying coping mechanisms are very helpful also to let the patient move forward. Being in the middle of creating hope but not so much as to give unrealistic hope can assist patient in decision-making.
How do we consider the client's emotions during the genetic counseling engagement?
Patient's emotions are very relevant during counseling sessions. Emotions can be as helpful as a motivator to want to learn, but it can also act in a negative way, in that it can cloud the patient's understanding of the disease. It also impacts how the patient will connect and build a relationship with the counselor. Sometimes the emotions can put the patient down so much that he feels very fragile.
Genetic counselors can deal with patient's emotions by first identifying the reason or the triggering factor for what the patient is feeling. Familial and psychosocial context, particularly family dynamics, fears and worries) should be explored as a dependent factor for the patient's emotions. The counselor should not stifle how the patient will express emotions. Rather, feelings and emotions of the patient should be encouraged to be brought out during the counseling session. The patient's well-being should be supported by providing support and validation. We should also assist the patient's coping mechanism so that their emotional issues be resolved. Once with resolution, they can handle understanding and decision-making.