Genetic Counseling Processes and Analogue Client Outcome

描述（由申请人提供）：遗传咨询提供了测试的新技术和个人参与知情决策过程的能力之间的翻译联系。 这些信息的密集和抽象性质，加上它所暗示的不确定性和疾病脆弱性的高度焦虑，可能会在认知和情感上压倒咨询客户。 过去20年的结果研究发现，很大一部分信息被误解或记忆不良;事实上，一些研究人员警告说，遗传咨询经验可能是一个重要的心理压力源，增加而不是减少疾病焦虑。 尽管咨询过程中的客户端的结果的关键作用，很少有结果的研究已经解决了互动的语言和情感的过程，包括沟通的咨询会议。 此外，在遗传咨询服务的用户中，少数民族和识字率低的人群在很大程度上代表性不足，并且对如何最好地为这些人群提供服务知之甚少。 目前的建议是一项两阶段研究，旨在解决这些关键问题。 在第一阶段，将从国家遗传咨询学会（NSGC）的会议上或通过区域中心招募200名遗传咨询师，在采访经过培训的模拟客户时进行录像，这些客户寻求与以下服务相关的服务：a）针对高龄产妇和囊性纤维化阳性家族史的产前检测咨询，或B）BRCA 1和BRCA 2基因突变的敏感性检测。非裔美国人或白人女性的模拟客户将单独或由男性模拟器作为客户的配偶在会议期间陪同进行采访。 研究的第二阶段招募了800名来自种族、地理和教育背景不同的人群的受试者，让他们观看录像带，同时想象自己是接受咨询的客户或配偶。 通过这种方式，受试者将作为模拟客户端（AC）提供一个代理客户满意度与咨询师的沟通，理解和回忆和焦虑的措施的人际和信息方面。

DESCRIPTION (provided by applicant): Genetic counseling provides the translational link between the new technologies of testing and the ability of individuals to engage in a process of informed decision making. The dense and abstract nature of this information, coupled with the heightened anxiety of uncertainty and disease vulnerability that it suggests, can be overwhelming to counseling clients - both cognitively and emotionally. Outcome studies over the past 20 years have found that a significant proportion of information is misunderstood or poorly recalled; indeed, some investigators have warned that the genetic counseling experience may be a significant psychological stressor increasing rather than diminishing disease anxiety. Despite the critical role of the counseling process to client outcomes, few outcome studies have addressed the interactive verbal and emotional processes that comprise the communication of counseling sessions. Furthermore, ethnic minorities and low literate populations are largely underrepresented among users of genetic counseling services and little is known about how to best serve these populations. The current proposal is a two-phase study designed to address these critical issues. In Phase 1, 200 genetic counselors will be recruited from meetings of the National Society of Genetic Counseling (NSGC), or through regional centers, to be videotaped while interviewing trained simulated clients seeking services related to either a) prenatal test counseling for advanced maternal age and a positive family history for cystic fibrosis, or b) susceptibility testing for BRCA1 and BRCA2 gene mutations. Simulated clients who are African American or Caucasian females will be used in interviews singly or accompanied by a male simulator acting as the client's spouse during the session. Phase 2 of the study recruits 800 subjects from ethnically, geographically, and educationally diverse populations to view the videotaped counseling sessions while imagining they are the client or the spouse being counseled. In this way, the subjects will act as analogue clients (AC) to provide a proxy for client satisfaction with the interpersonal and informational aspects of the counselor's communication, comprehension and recall and measures of anxiety.