Schoeffel Kara, McCarthy Veach Patricia, Rubin Karol, LeRoy Bonnie
Genomic Medicine, Aurora Health Care, Milwaukee, WI, USA.
Department of Genetics, Cell Biology, and Development, University of Minnesota, Minneapolis, MN, USA.
J Genet Couns. 2018 Sep;27(5):1275-1290. doi: 10.1007/s10897-018-0252-6. Epub 2018 Mar 22.
Research shows couple conflict occurring during prenatal genetic counseling sessions may be challenging for some genetic counselors. Yet, no study has explored couple conflict in depth. The current study investigated genetic counselors' experiences and perceptions of the nature and context of couple conflict in prenatal sessions and counselor conflict management strategies. Sixteen prenatal genetic counselors recruited through the National Society of Genetic Counselors participated in semi-structured phone interviews asking about how they recognize couple conflict; topics that trigger conflict and when it occurs; individual, cultural, and situational factors associated with conflict; conflict management strategies; and specific examples from their practice. Inductive and cross-case comparison methods revealed a number of themes. Genetic counselors recognize couple conflict through non-verbal and verbal cues, and conflict can occur at any time, particularly during decision-making about testing and test results and during results review of an affected pregnancy. Factors associated with conflict include cultural customs, age, emotional state, religious beliefs, and being forced to attend counseling. Participants identified 23 conflict management strategies classified into five themes: facilitate decision-making, encourage couple expression, act within one's scope of practice, provide psychosocial support, and support the identified patient. Counselors emphasized that their strategies are couple dependent. Patients may benefit from genetic counselors assessing couple conflict and intervening when it impedes genetic counseling goals. Clinical examples from this study may contribute to informing genetic counselor practice, program curricula, and continuing education workshops.
研究表明，产前遗传咨询过程中出现的夫妻冲突可能对一些遗传咨询师来说具有挑战性。然而，尚无研究深入探讨夫妻冲突。当前的研究调查了遗传咨询师在产前咨询中对夫妻冲突的性质、背景的经历和看法，以及咨询师的冲突管理策略。通过美国遗传咨询师协会招募的16名产前遗传咨询师参与了半结构化电话访谈，询问他们如何识别夫妻冲突；引发冲突的话题及冲突发生的时间；与冲突相关的个人、文化和情境因素；冲突管理策略；以及他们实践中的具体例子。归纳法和跨案例比较方法揭示了一些主题。遗传咨询师通过非语言和语言线索识别夫妻冲突，冲突可能在任何时候发生，特别是在关于检测和检测结果的决策过程中以及受影响妊娠的结果复查期间。与冲突相关的因素包括文化习俗、年龄、情绪状态、宗教信仰以及被迫参加咨询。参与者确定了23种冲突管理策略，分为五个主题：促进决策、鼓励夫妻表达、在执业范围内行事、提供心理社会支持以及支持指定的患者。咨询师强调他们的策略因夫妻而异。当夫妻冲突阻碍遗传咨询目标时，遗传咨询师对其进行评估并进行干预，患者可能会从中受益。本研究中的临床实例可能有助于为遗传咨询师的实践、项目课程和继续教育工作坊提供参考。
