Nonverbal communication and conversational contribution in breast cancer genetic counseling

Dijkstra, Henrietta; Albada, Akke; Cronauer, Christina Klöckner; Ausems, Margreet G. E. M.; Dulmen, Sandra van

doi:10.1016/j.pec.2013.05.014

Cited by 16 publications

(8 citation statements)

References 49 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…When a PCP spends more time looking at the computer, it may disrupt the flow of the conversation, and the PCP may be perceived as distracted, disengaged, and less patient-focused in the consultation [8]. While this may not be directly related to lower patient satisfaction per se, [21] it could affect how involved patients are in discussing their own concerns and needs [22]. …”

Section: Discussionmentioning

confidence: 99%

Provider interaction with the electronic health record: The effects on patient-centered communication in medical encounters

Street

Liu

Farber

et al. 2014

Patient Education and Counseling

133

View full text Add to dashboard Cite

Objective The computer with the electronic health record (EHR) is an additional ‘interactant’ in the medical consultation, as clinicians must simultaneously or in alternation engage patient and computer to provide medical care. Few studies have examined how clinicians' EHR workflow (e.g., gaze, keyboard activity, and silence) influences the quality of their communication, the patient's involvement in the encounter, and conversational control of the visit. Methods Twenty-three primary care providers (PCPs) from USA Veterans Administration (VA) primary care clinics participated in the study. Up to 6 patients per PCP were recruited. The proportion of time PCPs spent gazing at the computer was captured in real time via video-recording. Mouse click/scrolling activity was captured through Morae, a usability software that logs mouse clicks and scrolling activity. Conversational silence was coded as the proportion of time in the visit when PCP and patient were not talking. After the visit, patients completed patient satisfaction measures. Trained coders independently viewed videos of the interactions and rated the degree to which PCPs were patient-centered (informative, supportive, partnering) and patients were involved in the consultation. Conversational control was measured as the proportion of time the PCP held the floor compared to the patient. Results The final sample included 125 consultations. PCPs who spent more time in the consultation gazing at the computer and whose visits had more conversational silence were rated lower inpatient-centeredness. PCPs controlled more of the talk time in the visits that also had longer periods of mutual silence. Conclusions PCPs were rated as having less effective communication when they spent more time looking at the computer and when there was more periods of silence in the consultation. Because PCPs increasingly are using the EHR in their consultations, more research is needed to determine effective ways that they can verbally engage patients while simultaneously managing data in the EHR. Practice implications EHR activity consumes an increasing proportion of clinicians' time during consultations. To ensure effective communication with their patients, clinicians may benefit from using communication strategies that maintain the flow of conversation when working with the computer, as well as from learning EHR management skills that prevent extended periods of gaze at computer and long periods of silence. Next-generation EHR design must address better usability and clinical workflow integration, including facilitating patient-clinician communication.

show abstract

Section: Discussionmentioning

confidence: 99%

Provider interaction with the electronic health record: The effects on patient-centered communication in medical encounters

Street

Liu

Farber

et al. 2014

Patient Education and Counseling

133

View full text Add to dashboard Cite

show abstract

“…In contrast, meeting clients' expectations for information has not been associated with improved emotional outcomes. Higher counselor verbal dominance is also associated with higher anxiety levels and lower perceived needs fulfillment, highlighting the importance of client engagement and collaboration in the genetic counseling session (Dijkstra et al 2013;Meiser et al 2008;Roter et al 2006). Clients also tend to have greater improvements in depression levels when counselors use more empathic responses (Duric 2003;Meiser et al 2008), and consistently rate higher satisfaction with practice models that emphasize counseling over teaching (Roter et al 2006).…”

Section: Teaching and Counseling Models In Genetic Counselingmentioning

confidence: 99%

Conceptualizing Genetic Counseling as Psychotherapy in the Era of Genomic Medicine

Austin

Semaka

Hadjipavlou

2014

Journal of Genetic Counseling

119

105

View full text Add to dashboard Cite

Discussions about genetic contributions to medical illness have become increasingly commonplace. Physicians and other health-care providers in all quarters of medicine, from oncology to psychiatry, routinely field questions about the genetic basis of the medical conditions they treat. Communication about genetic testing and risk also enter into these conversations, as knowledge about genetics is increasingly expected of all medical specialists. Attendant to this evolving medical landscape is some uncertainty regarding the future of the genetic counseling profession, with the potential for both increases and decreases in demand for genetic counselors being possible outcomes. This emerging uncertainty provides the opportunity to explicitly conceptualize the potentially distinct value and contributions of the genetic counselor over and above education about genetics and risk that may be provided by other health professionals.In this paper we suggest conceptualizing genetic counseling as a highly circumscribed form of psychotherapy in which effective communication of genetic information is a central therapeutic goal. While such an approach is by no means new-in 1979 Seymour Kessler explicitly described genetic counseling as a "kind of psychotherapeutic encounter," an "interaction with a psychotherapeutic potential"-we expand on his view, and provide research evidence in support of our position. We review available evidence from process and outcome studies showing that genetic counseling is a therapeutic encounter that cannot be reduced to one where the counselor performs a simple "conduit for information" function, without losing effectiveness. We then discuss potential barriers that may have impeded greater uptake of a psychotherapeutic model of practice, and close by discussing implications for practice.

show abstract

“…Findings included: 1) tailoring by the genetic counselor did not affect distress, knowledge, and risk (Lobb et al 2002b); 2) counselees preferences for risk communication differ (Lobb et al 2003); 3) empathic expressions from the genetic counselor were associated with decreased depression but not anxiety (Duric et al 2003); 4) a greater number of aspects discussed was associated with decreased distress (Lobb et al 2004); 5) greater genetic counselor verbal dominance was associated with greater post-counseling anxiety (Dijkstra et al 2013). Other studies have found counselors focused more on educational issues (Ellington et al 2006; Ellington et al 2005), while consultands/participants focused more on psychosocial issues (Pieterse et al 2005).…”

Section: Introductionmentioning

confidence: 99%

Linking Genetic Counseling Content to Short‐Term Outcomes in Individuals at Elevated Breast Cancer Risk

Kelly

Ellington

Schoenberg

et al. 2014

Journal of Genetic Counseling

View full text Add to dashboard Cite

Few studies have linked actual genetic counseling content to short-term outcomes. Using the Self-regulation Model, the impact of cognitive and affective content in genetic counseling on short-term outcomes was studied in individuals at elevated risk of familial breast-ovarian cancer. Surveys assessed dependent variables: distress, perceived risk, and 6 knowledge measures (Meaning of Positive Test; Meaning of Negative Test; Personal Behavior; Practitioner Knowledge; Mechanisms of Cancer Inheritance; Frequency of Inherited Cancer) measured at pre- and post-counseling. Proportion of participant cognitive and affective and counselor cognitive and affective content during sessions (using LIWC software) were predictors in regressions. Knowledge increased for 5 measures and decreased for Personal Behavior, Distress and Perceived Risk. Controlling for age and education, results were significant/marginally significant for three measures. More counselor content was associated with decreases in knowledge of Personal Behavior. More participant and less counselor affective content was associated with gains in Practitioner Knowledge. More counselor cognitive, and interaction of counselor cognitive and affective content, were associated with higher perceived risk. Genetic counselors dominate the content of counseling sessions. Therefore, their content is tied more closely to short term outcomes than participant content. A lack of patient communication in sessions may pose problems for understanding of complex concepts.

show abstract

Nonverbal communication and conversational contribution in breast cancer genetic counseling

Cited by 16 publications

References 49 publications

Provider interaction with the electronic health record: The effects on patient-centered communication in medical encounters

Provider interaction with the electronic health record: The effects on patient-centered communication in medical encounters

Conceptualizing Genetic Counseling as Psychotherapy in the Era of Genomic Medicine

Linking Genetic Counseling Content to Short‐Term Outcomes in Individuals at Elevated Breast Cancer Risk

Contact Info

Product

Resources

About