Assessing Shared Decision‐Making Clinical Behaviors Among Genetic Counsellors

• Published in: Journal of genetic counseling Vol. 28; no. 1; pp. 40 - 49
• Main Authors: Birch, Patricia H., Adam, S., Coe, R. R., Port, A. V., Vortel, M., Friedman, J. M., Légaré, F.
• Format: Journal Article
• Language: English
• Published: United States Blackwell Publishing Ltd 01.02.2019
• Subjects: Antenatal; Anxiety; Behavior; Clinical decision making; Clinical outcomes; Collaborative approach; Counselors; Decision making; Decisional conflict; Evidence-based practice; Genetic counseling; Genetic counselling; Group decision making; Health status; Infants; OPTION12; Patient participation; Pregnancy; Prenatal care; Shared decision‐making; Training; Pregnancy; OPTION12; Evidence-based practice; Anxiety; Decisional conflict; Genetic counselling; Shared decision-making
• ISSN: 1059-7700; 1573-3599
• DOI: 10.1007/s10897-018-0285-x

Shared decision‐making (SDM) is a collaborative approach in which clinicians educate, support, and guide patients as they make informed, value‐congruent decisions. SDM improves patients' health‐related outcomes through increasing knowledge, reducing decisional conflict, and enhancing experience of care. We measured SDM in genetic counselling appointments with 27 pregnant women who were at increased risk to have a baby with a genetic abnormality. The eight experienced genetic counsellors who participated had no specific SDM training and were unaware that SDM was being assessed. Audio transcripts of appointments were scored using ‘Observing Patient Involvement in Decision Making' (OPTION12). Patients' anxiety and decisional conflict were also assessed. The genetic counsellors' mean OPTION12score was 42.4% (SD 9.0%; possible range 0–100%). Specific SDM behaviours that scored highest included introducing the concept of equipoise and listing all options with their pros and cons. Behaviours that scored lowest included eliciting patients' preferred approach to receiving information and desired degree of involvement in decision‐making. Patients' levels of anxiety and decisional conflict were unassociated with genetic counsellors' OPTION12scores. Some SDM behaviours were better demonstrated in this prenatal genetic counselling study than others. Formal training of genetic counsellors in SDM may enhance use of this approach in their professional practice.