Department of Genetics, Nemours Children's Hospital, Orlando, Florida, USA.
Department of Genetics, Cell Biology, and Development, University of Minnesota - Twin Cities, Minneapolis, Minnesota, USA.
J Genet Couns. 2024 Jun;33(3):578-591. doi: 10.1002/jgc4.1758. Epub 2023 Aug 2.
Genetic counseling (GC) relies on communication to help people understand and adapt to genetic contributions of disease, and there is need for a practical and reliable method of comprehensively documenting GC communication skills without intensive coding. To this end, we created a novel process measure called the Genetic Counseling Skills Checklist (GCSC), utilizing previously validated measures, communication/counseling frameworks, and prior research findings. A multistage iterative process was used to develop, evaluate, and modify the GCSC to improve its clarity, usability, and content validity. To assess interrater reliability, randomly assigned, untrained individuals (i.e., coders) used the GCSC version 3 to code multiple simulated GC sessions. Average measures intraclass correlation coefficients (ICCs) were calculated for each of the 8 GCSC process categories using one-way, random effects models. After relatively minor modifications to the GCSC, two pairs of experienced coders used GCSC version 4 to independently code additional GC sessions and Cohen's Kappa coefficients (κ) were calculated to assess interrater reliability for each process category. The GCSC contains five to eight items within each category and demonstrates good content validity given its ability to capture nearly all GC skills that genetic counselors reported using in a prior qualitative study. Interrater reliability of GCSC version 3 among coders with limited experience was moderate or good for 6 out of the 8 process categories as evidenced by ICCs ranging from 0.55 to 0.86. Average interrater reliability of GCSC version 4 among one pair of experienced coders was strong for all eight process categories (κ ranging from 0.82 to 0.94); among the second pair of experienced coders scores were strong for six categories (κ ranging from 0.80 to 0.87) and moderate for two categories (κ of 0.77 and 0.78). The results suggest the need for training and experience to assure adequate interrater reliability across GCSC coders. Future work is needed to create a formalized training program for coders, complete a larger study to further validate the measure, and use the GCSC to document variability in skills used across providers and sessions.
遗传咨询（GC）依赖于沟通，以帮助人们理解和适应疾病的遗传贡献，因此需要一种实用且可靠的方法来全面记录 GC 沟通技巧，而无需进行密集编码。为此，我们创建了一种新的过程衡量标准，称为遗传咨询技能检查表（GCSC），该标准利用了先前经过验证的衡量标准、沟通/咨询框架以及先前的研究结果。利用多阶段迭代过程来开发、评估和修改 GCSC，以提高其清晰度、可用性和内容有效性。为了评估评分者间的可靠性，随机分配未经培训的个体（即编码员）使用 GCSC 版本 3 对多个模拟 GC 会话进行编码。使用单向、随机效应模型为 GCSC 的 8 个过程类别中的每一个计算平均度量组内相关系数（ICC）。在对 GCSC 进行相对较小的修改之后，两对经验丰富的编码员使用 GCSC 版本 4 独立地对额外的 GC 会话进行编码，并计算每个过程类别的 Cohen's Kappa 系数（κ）以评估评分者间的可靠性。GCSC 每个类别包含五到八项内容，并且鉴于其能够捕获遗传咨询师在先前的定性研究中报告使用的几乎所有 GC 技能，因此具有良好的内容有效性。经验有限的编码员对 GCSC 版本 3 的评分者间可靠性为中度或良好，证据为 ICC 范围从 0.55 到 0.86。一对经验丰富的编码员对 GCSC 版本 4 的平均评分者间可靠性为所有 8 个过程类别均为强（κ范围从 0.82 到 0.94）；对于第二对经验丰富的编码员，六个类别的分数为强（κ范围从 0.80 到 0.87），两个类别的分数为中度（κ为 0.77 和 0.78）。结果表明，需要对编码员进行培训和经验，以确保 GCSC 编码员之间具有足够的评分者间可靠性。未来的工作需要为编码员创建一个正式的培训计划，完成一项更大的研究以进一步验证该衡量标准，并使用 GCSC 来记录提供者和会话之间使用的技能的差异。
