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

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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.