Leach Emma, Morris Emily, White Hannah J, Inglis Angela, Lehman Anna, Austin Jehannine
Department of Medical Genetics, University of British Columbia, Vancouver, Canada.
Department of Psychiatry, University of British Columbia, Rm A3-112, CFRI Translational Lab Building, 938 W 28th Ave, Vancouver, BC, V5Z 4H4, Canada.
J Genet Couns. 2016 Dec;25(6):1235-1242. doi: 10.1007/s10897-016-9961-x. Epub 2016 May 17.
Psychiatric genetic counseling (PGC) is an emerging specialty discipline within the genetic counseling profession. A specialist PGC service was founded in 2012 in Vancouver, Canada, and though patient benefits have been demonstrated, many physicians do not regularly refer patients to the service despite awareness of its availability. We conducted a qualitative study involving semi-structured telephone interviews with Vancouver-based physicians who were aware of the PGC service to explore this phenomenon. Interviews were audio-recorded, transcribed verbatim, coded, and analysed for emergent themes. Consistent with a grounded theory approach, constant comparison was employed throughout data collection and analysis. Analyses of interviews conducted with 12 physicians revealed that referral practices were informed by perceptions about the purpose of PGC and interpretation of patient cues. Physicians perceived PGC as an information-focused intervention, and considered referral when patients explicitly expressed desire for information about recurrence risk or etiology that they felt unable to adequately address themselves. Even when physicians identified psychotherapeutic benefits of PGC, patient needs of this nature were not perceived as cues prompting referral to PGC. These data suggest that further work is necessary to position PGC in physicians' minds as a service that could potentially benefit most individuals with psychiatric disorders and their families, and that it encompasses more than information provision. It is important to increase physicians' awareness of the complementary role that genetic counselors can play to that of the physician in providing psychotherapeutically oriented counselling about illness etiology.
精神科遗传咨询（PGC）是遗传咨询领域中一个新兴的专业学科。2012年，加拿大温哥华成立了一家专业的PGC服务机构，尽管已证明该服务对患者有益，但许多医生尽管知晓该服务的存在，却并不经常将患者转介至该服务机构。我们开展了一项定性研究，对温哥华地区知晓PGC服务的医生进行了半结构化电话访谈，以探究这一现象。访谈进行了录音，逐字转录，编码，并对浮现的主题进行分析。与扎根理论方法一致，在整个数据收集和分析过程中都采用了持续比较法。对12名医生进行的访谈分析显示，转介行为受到对PGC目的的认知以及对患者线索的解读的影响。医生们将PGC视为一种以信息为重点的干预措施，当患者明确表示希望了解复发风险或病因信息，而医生认为自己无法充分解答时，才会考虑转介。即使医生认识到PGC具有心理治疗益处，但这类患者需求并未被视为促使转介至PGC的线索。这些数据表明，有必要开展进一步工作，让医生认识到PGC可能会使大多数精神疾病患者及其家属受益，而且其涵盖的内容不止于提供信息。提高医生对遗传咨询师在提供有关疾病病因的心理治疗导向咨询方面可以与医生发挥互补作用的认识非常重要。
