Albada Akke, Ausems Margreet G E M, van Dulmen Sandra
Department of Medical Genetics, University Medical Centre Utrecht, Postbus 85500, 3508 AB Utrecht, The Netherlands; NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands.
Department of Medical Genetics, University Medical Centre Utrecht, Postbus 85500, 3508 AB Utrecht, The Netherlands.
Soc Sci Med. 2014 Sep;116:178-86. doi: 10.1016/j.socscimed.2014.07.012. Epub 2014 Jul 6.
The purpose of the study was to assess the counselee participation in the follow-up visits, compared to the first visits, for breast cancer genetic counselling and to explore associations with counselees' achievement of their preferred role in decision making, information recall, knowledge, risk perception alignment and perceived personal control. First and follow-up visits for breast cancer genetic counselling of 96 counselees of a Dutch genetics center were videotaped (2008-2010). Counselees completed questionnaires before counselling (T1), after the follow-up visit (T2) and one year after the follow-up visit (T3). Consultations were rated with the Roter Interaction Analysis System (RIAS). Counselee participation was measured as the percentage of counselee utterances, the percentage of counselee questions and the interactivity (number of turns per minute). Follow-up visits had higher levels of counselee participation than first visits as assessed by the percentage of counselee talk, the interactivity and counselee questions. More counselee talk in the follow-up visit was related to higher achievement of the preferred role (T2) and higher perceived personal control (T3). Higher interactivity in the follow-up visit was related to lower achievement of the preferred role in decision making and lower information recall (T2). There were no significant associations with the percentage of questions asked and none of the participation measures was related to knowledge, risk perception alignment and perceived personal control (T2). In line with the interviewing admonishment 'talk less and listen more', the only assessment of counselee participation associated to better outcomes is the percentage of counselee talk. High interactivity might be associated with lower recall in breast cancer genetic counselees who are generally highly educated. However, this study was limited by a small sample size and a heterogeneous group of counselees. Research is needed on the interactions causing interactivity and its relationships with involvement in decision making and recall.
本研究的目的是评估乳腺癌遗传咨询后续随访中咨询对象的参与度，并与首次咨询进行比较，同时探讨其与咨询对象在决策中实现偏好角色、信息回忆、知识、风险认知一致性以及感知到的个人控制之间的关联。荷兰一家遗传学中心对96名乳腺癌遗传咨询对象的首次和后续随访进行了录像（2008年至2010年）。咨询对象在咨询前（T1）、随访后（T2）以及随访后一年（T3）完成问卷调查。使用罗特互动分析系统（RIAS）对咨询过程进行评分。咨询对象的参与度通过咨询对象话语的百分比、咨询对象问题的百分比以及互动性（每分钟轮次）来衡量。通过咨询对象谈话的百分比、互动性和咨询对象问题评估，后续随访中咨询对象的参与度高于首次咨询。后续随访中咨询对象更多的谈话与在偏好角色方面更高的实现程度（T2）以及更高的感知到的个人控制（T3）相关。后续随访中更高的互动性与在决策中偏好角色的较低实现程度以及较低的信息回忆（T2）相关。所问问题的百分比没有显著关联，并且没有一项参与度衡量指标与知识、风险认知一致性以及感知到的个人控制（T2）相关。与“少说多听”的访谈告诫一致，与更好结果相关的咨询对象参与度的唯一评估指标是咨询对象谈话的百分比。高互动性可能与乳腺癌遗传咨询对象（他们通常受教育程度较高）较低的回忆相关。然而，本研究受样本量小和咨询对象群体异质性的限制。需要对导致互动性的互动及其与决策参与和回忆的关系进行研究。
