Invision Sally Jobe, Greenwood Village, Colorado, USA.
University of Minnesota, Minneapolis, Minnesota, USA.
J Genet Couns. 2023 Feb;32(1):197-212. doi: 10.1002/jgc4.1634. Epub 2022 Sep 21.
Research shows religiosity and spirituality (R/S) influence genetic counseling patients' and families' risk perception, decision-making, and coping. No published studies have examined how genetic counselors respond to patient-initiated R/S statements. This exploratory study examined genetic counselors' response types and reasons for their responses to two prenatal patient's R/S statements. Genetic counselors (n = 225) recruited through a National Society of Genetic Counselors eblast completed a survey containing two hypothetical scenarios regarding a prenatal patient's receipt of a trisomy 18 diagnosis. Scenarios were identical except for the last patient statement: "God makes everything possible…we leave things in his hands" (a deferring statement) or "I feel like God is punishing me for something I did" (an attributing statement). Imagining they were the counselor, participants wrote a response to each scenario and provided reasons for their response. Responses were analyzed using the Helping Skills Verbal Response System. MANOVA and chi-square tests, examining differences in response type based on patient statement (deferring or attributing), participant comfort with R/S, and years of experience, yielded a significant multivariate effect for scenario (p < 0.001). Responses to the deferring statement scenario contained a greater proportion of content statements (p < 0.001), closed questions (p < 0.001), and information-giving (p < 0.001). Responses to the attributing statement scenario contained a greater proportion of open questions (p = 0.05), influencing statements (p < 0.001), and affective statements (p = 0.006). Neither comfort with R/S nor genetic counseling experience significantly affected response type. Thematic analysis of reasons for responses yielded nine themes. Most prevalent were exploration (of the patient's statement), validation, correction (of patient's beliefs), and reassurance. The findings reflect stylistic differences in how and why genetic counselors respond to patients.
研究表明，宗教信仰和精神信仰（R/S）会影响遗传咨询患者及其家属的风险感知、决策和应对方式。目前尚未有研究探讨遗传咨询师如何回应患者提出的与 R/S 相关的问题。本探索性研究调查了遗传咨询师对两位接受产前诊断的患者提出的 R/S 问题的回应类型及其回应原因。通过全美遗传咨询师协会的电子邮件广告招募的 225 名遗传咨询师参与了这项研究，他们填写了一份包含两个关于接受唐氏综合征 18 三体诊断的产前患者的假设情景的调查。两个情景完全相同，除了患者的最后一句话：“上帝让一切皆有可能……我们将一切交托给他”（一句推诿的话）或“我觉得上帝在因为我做过的某件事而惩罚我”（一句归因的话）。想象自己是咨询师，参与者要对每个情景写出回应，并给出回应的原因。采用 Helping Skills Verbal Response System 对回应进行分析。基于患者的陈述（推诿或归因）、参与者对 R/S 的舒适程度以及从业年限，运用 MANOVA 和卡方检验，对不同的回应类型进行了分析，结果显示情景存在显著的多变量效应（p<0.001）。对于推诿情景的回应中包含更多的内容陈述（p<0.001）、封闭性问题（p<0.001）和信息提供（p<0.001）。对于归因情景的回应中包含更多的开放性问题（p=0.05）、影响性陈述（p<0.001）和情感性陈述（p=0.006）。对 R/S 的舒适程度和遗传咨询经验都没有显著影响回应类型。对回应原因的主题分析产生了九个主题。最常见的是探索（患者的陈述）、验证、纠正（患者的信仰）和安慰。研究结果反映了遗传咨询师回应患者的方式和原因存在风格差异。
