Psychological aspects of genetic counseling: VI. A critical review of the literature dealing with education and reproduction.

The post-1979 literature dealing with the educational and reproductive outcome and process of genetic counseling is reviewed. Despite methodological difficulties, recent publications strongly suggest that genetic counseling is successful in educating counselees about diagnostic and risk information. In general, investigators suggest that there is room for improvement and the factors leading to imperfect recall of information need to be elucidated. Process studies suggest that the educational priorities of counselors and counselees may not always be consistent. The contribution of these inconsistencies to outcome measures needs further study. Also, it appears that differing counseling approaches may be equally effective in achieving educational goals. Studies on the reproductive outcome of genetic counseling show no strong impact of counseling; there appears to be a net increase of desire for more children following counseling. Precounseling reproductive intentions, rather than counseling, were found to be a major factor in determining postcounseling outcome. Process studies suggest that although many counselees say that they were influenced by genetic counseling, it is uncertain what they mean, since for many counselees, reproductive decisions seem to have been made prior to counseling.