Piloting a standardized psychosocial assessment tool (BATHE) in genetic counseling

项目摘要 在一系列遗传咨询中，发现患者的心理困扰率很高 在癌症、心脏病、产前和医学遗传学等领域开展的研究。在许多情况下，这些需求是深刻的 和未满足。这些数据表明，提供临床护理的遗传咨询师应该定期评估患者的遗传病。 情绪和心理影响。遗传咨询的认证委员会需要这种技能来实现 认证，但在遗传咨询中没有“心理社会评估”的标准定义， 通用工具来促进它。那些确实存在的工具是基于医疗器械的或特定于临床的 适应症，如遗传性癌症我们可以看看其他医疗机构，如社会工作和小学 护理，借用标准化的心理社会评估工具，这可能适用于遗传 辅导在初级保健中开发的一种这样的工具是BATHE方法：一种结构化技术， 四个问题，探讨病人的主要提出的关注，情绪影响和应对，配对 共情反应的指导。来自初级保健文献的证据表明，BATHE方法可减少 患者焦虑并改善患者赋权。供应商发现它简洁易学，允许 以人为本的互动，而不增加咨询时间。这些特点使其成为 一个有吸引力的工具，以试点遗传咨询，提供以病人为中心的护理，同时平衡信息 交付和支持。因此，我们通过NHGRI R21机制申请资金， 描述心理社会实践的现状，并试行一种创新的标准化方式， 遗传咨询中的评估。这些目标符合NHGRI的2020年战略愿景， 围绕基因组信息促进患者赋权，并培训可扩展且高效的员工队伍。 首先，本研究将描述遗传咨询中心理社会评估的现行做法， 斯坦福大学遗传咨询会议记录的描述性内容分析 药第二，本研究将在遗传学领域试行一种社会心理评估工具（BATHE方法）。 由遗传咨询师评估其可行性和可接受性。探索病人的观点， 患者相关的结果和文化差异的影响至关重要，目前的研究奠定了 为后续研究奠定基础。在我们的研究结束时，我们的目标的结果将告知 制定专门针对遗传咨询的标准化心理社会评估。的最终目标 这项研究是建立一个基础，调查病人的结果，在回应心理社会 咨询方法。

PROJECT ABSTRACT Significant rates of psychological distress have been found in patients across a range of genetic counseling settings, including cancer, cardiology, prenatal and medical genetics. In many cases, these needs are profound and unmet. Such data suggest that genetic counselors providing clinical care should routinely assess patients’ emotions and psychological impact. Accreditation boards for genetic counseling require this skill to achieve certification, but there is no standard definition of a “psychosocial assessment” in genetic counseling nor universal instruments to facilitate it. Those tools that do exist are questionnaire-based or specific to a clinical indication, eg. hereditary cancer. We can look to other healthcare settings, such as social work and primary care, to borrow tools which standardize the psychosocial assessment and which may be applicable in genetic counseling. One such tool developed in primary care is the BATHE method: a structured technique consisting of four questions that explore patients’ main presenting concerns, emotional affect and coping, paired with guidance for empathic responses. Evidence from the primary care literature shows the BATHE method reduces patient anxiety and improves patient empowerment. Providers find it concise and easy-to-learn, allowing for a person-centered interaction without increasing consultation time. These characteristics combined make it an attractive tool to pilot in genetic counseling, which provides patient-centered care while balancing information delivery and support. For these reasons, we request funding through this NHGRI R21 mechanism to better characterize the current state of psychosocial practices and pilot an innovative standardized way to provide such an assessment in genetic counseling. These goals are in line with the NHGRI’s 2020 Strategic Vision to promote patient empowerment around genomic information and train a workforce that is scalable and efficient. First, this study will describe the current practices of psychosocial assessments in genetic counseling, using descriptive content analysis of transcripts of a purposive sample of genetic counseling sessions at Stanford Medicine. Second, this study will pilot a psychosocial assessment tool (the BATHE method) in genetic counseling to assess its feasibility and acceptability by genetic counselors. Exploring patients’ perspectives, patient-related outcomes, and influence of cultural differences are crucial, and the current study lays the groundwork for this subsequent research. At the conclusion of our study, the findings from our aims will inform the development of a genetic counseling-specific standardized psychosocial assessment. The ultimate goal of this research is to build a foundation for investigation of patient outcomes in response to psychosocial counseling approaches.