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

项目摘要 在一系列遗传咨询的患者中发现了显著的心理痛苦发生率。 环境，包括癌症、心脏病、产前和医学遗传学。在许多情况下，这些需求是深刻的 也没有被满足。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 情绪和心理影响。遗传咨询认证委员会需要这项技能才能实现 认证，但在遗传咨询中也没有“心理社会评估”的标准定义 通用的工具来促进这一点。那些确实存在的工具是基于问卷的或特定于临床的 指示，例如。遗传性癌症。我们可以参考其他医疗保健机构，如社会工作和初级保健 护理，借用标准化的心理社会评估工具，这些工具可能适用于遗传学 心理咨询。在初级保健中开发的一种这样的工具是洗澡方法：一种结构化的技术，包括 在探索患者主要表现关切、情绪影响和应对的四个问题中，配对 同理心反应指南。来自初级保健文献的证据表明，洗澡方法减少了 患者的焦虑，并提高患者的能力。提供商发现它简明易学，允许 以人为中心的互动，而不增加咨询时间。这些特点结合在一起，使其成为 诱人的遗传咨询试点工具，提供以患者为中心的护理，同时平衡信息 交付和支持。出于这些原因，我们通过NHGRI R21机制申请资金，以更好地 描述心理社会实践的当前状态，并试点一种创新的标准化方式，以提供 在遗传咨询中这样的评估。这些目标与NHGRI 2020年的战略愿景一致 围绕基因组信息促进患者赋权，并培训一支可扩展且高效的员工队伍。 首先，这项研究将描述目前遗传咨询中心理社会评估的实践，使用 斯坦福大学有目的的遗传咨询会议记录的描述性内容分析 医学。其次，本研究将试行一种心理社会评估工具(洗澡方法)。 遗传咨询师评估其可行性和可接受性。探索病人的视角， 与患者相关的结果和文化差异的影响是至关重要的，目前的研究奠定了 为后续研究做好铺垫。在我们的研究结束时，来自我们AIMS的发现将提供信息 制定专门针对遗传咨询的标准化心理社会评估。的最终目标是 本研究旨在为研究心理社会反应对患者预后的影响奠定基础。 心理咨询就要来了。

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.