Validation and Extension of the Reciprocal-Engagement Model of Genetic Counseling Practice: A Qualitative Investigation of Genetic Counselor Goals, Strategies, and Behaviors

Abstract

As the genetic counseling profession steadily evolves, in part due to continual advances in genetic technology, there is a growing need to establish a validated model of practice. The Reciprocal-Engagement Model (REM; McCarthy Veach et al., 2007) is a recently proposed model comprised of five tenets and 17 corresponding goals. Two studies to date provide evidence of its validity (Hartmann et al., 2015; Redlinger-Grosse et al., 2015); thus, the REM remains a "work in progress." The purpose of the present study was to further develop and validate the REM by identifying genetic counselors' and genetic counseling researchers’ perceptions of strategies and behaviors that occur in genetic counseling sessions and mapping said strategies and behaviors to the 17 REM goals. A secondary, qualitative analysis was conducted on data obtained in two prior studies: 1) focus group results of genetic counselors’ and researchers’ perceptions of genetic counseling outcomes (Redlinger-Grosse et al. 2015); and 2) genetic counselor practitioners’ examples of their successful and unsuccessful genetic counseling sessions (Geiser, 2009). Using directed content analysis methods, the focus group data were further analyzed to yield 337 strategies and 140 behaviors. A Q-sort performed on the 337 strategies yielded 15 broader strategy domains. These domains were then used in a second directed content analysis to map REM goals and corresponding strategy domains onto examples of 67 successful and 63 unsuccessful genetic counseling sessions. Additional validation of the REM goals was noted based on differing proportions of strategy domains identified in successful sessions versus the proportions not present in unsuccessful sessions. For successful sessions, the most frequent domains were "Information Giving" and "Use Psychosocial Counseling Skills and Strategies." For unsuccessful sessions, the most frequent domains that were not present were "Information Giving" and "Working Alliance." These results support the reciprocal nature of the REM, especially with respect to addressing patients’ informational and psychosocial needs. Data analysis further revealed patients' characteristics and/or behaviors contributed either to success (or lack thereof) of the genetic counseling sessions, supporting a REM tenet that the genetic counselor-patient relationship is central to processes and outcomes. The present results have implications for training and research. For example, the elaborated REM could be incorporated into training program curricula and used to demonstrate how the Accreditation Council for Genetic Counseling (ACGC) practice based competencies are accomplished. REM components could inform studies of genetic counseling processes and outcomes. Further empirical validation of the REM is warranted, including documenting genetic counseling strategies and behaviors in observational or analogue studies.