Bartels D M, LeRoy B S, McCarthy P, Caplan A L
Center for Bioethics, University of Minnesota, Minneapolis 55455, USA.
Am J Med Genet. 1997 Oct 17;72(2):172-9.
The literature defines nondirectiveness as a genetic counseling strategy that supports autonomous decision-making by clients [Fine, 1993]. This study surveyed 781 full members of the National Society of Genetic Counselors (NSGC) between April and June, 1993, to assess how they define nondirectiveness, its importance to their practice, and how and why they are ever directive. Almost 96% of 383 respondents reported viewing nondirectiveness as very important, but 72% stated they are sometimes directive. The most common reasons for directiveness include: difficulties ensuring that verbal and nonverbal cues remain nondirective; to recommend testing; client is unable to understand; a better choice is clear; to recommend medical care or counseling; or when a client has difficulty making a decision. Nonsignificant Chi-square analyses indicated that counselor responses were independent of counselor demographics. While these findings suggest that nondirectiveness is a goal in genetic counseling, it is not the only goal. Recognition of the delicate balance between directing the process and defining the outcome of genetic counseling can enhance clinicians' ability to discern the circumstances under which directiveness is and is not appropriate.
文献将非指导性定义为一种遗传咨询策略，它支持客户自主决策[法恩，1993年]。本研究在1993年4月至6月期间对全国遗传咨询师协会（NSGC）的781名正式会员进行了调查，以评估他们如何定义非指导性、其对他们执业的重要性，以及他们如何以及为何会具有指导性。在383名受访者中，近96%的人表示认为非指导性非常重要，但72%的人表示他们有时会具有指导性。具有指导性的最常见原因包括：难以确保言语和非言语暗示保持非指导性；推荐检测；客户无法理解；明显有更好的选择；推荐医疗护理或咨询；或者当客户难以做出决定时。无显著差异的卡方分析表明，咨询师的回答与咨询师的人口统计学特征无关。虽然这些发现表明非指导性是遗传咨询的一个目标，但它不是唯一的目标。认识到在引导咨询过程和确定遗传咨询结果之间的微妙平衡，可以提高临床医生辨别指导性何时合适、何时不合适的能力。
