Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Board Review 2024 > Psychosocial Counseling (Green Book) > Flashcards

Psychosocial Counseling (Green Book) Flashcards

1
Q

What is the eugenic model of genetic counseling

A

Galton coined the term eugenics in 1885 to become the study of “agencies under social control that may improve or impair racial qualities of future generations, either physically or mentally
By 1926, 23 of the 48 US states had laws mandating sterilization of the “mentally defective” and over 6000 people had been sterilized

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the Immigration Restriction Act of 1924

A

US instituted quotas to limit immigration of various “inferior” ethnic groups
These past abuses are at the heart of the nondirective approach today

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the medical/preventive model of genetic counseling

A

By the mid 1940s, prevention had become the new focus of medicine and info about risks were based upon empirical observations
few dx tests available, no way to identify unaffected carriers of genetic conditions
Little to GCing except to offer sympathy and give the option of avoiding childbearing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the decision making model of genetic counseling

A

Discovery of cyto for T21, KS, Turner, and T18/13 as well as the carrier statuses for metabolic dz’s and hemoglobinopathies were used for prenatal dx
shifted to educating about risks, exploring decisions about reproduction, testing, and/or management based on pt’s beliefs/values

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the psychotherapeutic model of genetic counseling

A

exploring emotional responses, goals, cultural/religious beliefs, etc. has become integral to GCing process

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What does pt education entail (aka what is the bare minimum we need to discuss with a pt)

A

features, natural hx, and variability of the condition
its’ genetic basis
how it is dx/managed
chances it will occur/reoccur in a family
economic, social, and psychological impacts
resources available
strategies to fix/prevent the condition
relevant research

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the genetic counselor’s scope of practice (via NSGC 2024)

A
  1. obtain and evaluate individual, family, and medical hx to determine risk for genetic/medical conditions and dz in a pt, their offspring, and other family members
  2. discuss the features, natural hx, means of dx, genetic and environmental factors, and management of risk for genetic/medical conditions and dz’s
  3. identify, order, and coordinate genetic tests and other dx studies as appropriate
  4. integrate genetic test results and other dx studies w personal and FH to assess and communicate risk factors for genetic conditions
  5. explain the clinical implications of genetic tests and other dx studies and their results
  6. evaluate the pt’s or family’s responses to the condition or recurrence risk and provide client-centered counseling and anticipatory guidance
  7. identify and utilize community resources that provide medical, educational, financial, and psychosocial support and advocacy
  8. provide written documentation of medical, genetic, and counseling info for families and HCPs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What can a pedigree help to reveal

A

reveals patients who require increased medical surveillance, preventive measures, or genetic counseling and testing referral
facilitates the client’s ability to use genetic info in a personally meaningful way that minimizes psychological distress and increases personal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Who is the consultand? The proband?

A

consultand: individual seeking genetic evaluation, counseling, or testing who may or may not be affected

proband: designates the affected family member who brings the family to medical attention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Describe the relationship between first cousins once removed? twice removed? second cousins once removed?

A

First cousins once removed: a pt’s 1st cousins’ child
First cousins twice removed: a pt’s 1st cousins’ grandchild
Second cousins once removed: relationship between a pt’s grandchild and the pt’s 1st cousins’ child

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Describe three factors that need to be considered in the interpretation of FH data

A

Variable expressivity: disorders may present diversely within a familt (especially dominant ones), and in some instances the sum of the varying manifestations among multiple family members will suggest the dx for a particular disorder
reduced penetrance: identify at-risk relatives and recommend evaluation/genetic counseling since potential medical/health implications should be addressed
value of an extended negative hx: provides info that is often as impt as a hx of a genetic condition in a family- can reduce risks (think Bayes)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Who is Carl Rogers and what did he describe

A

Described key attributes to the GC session (respect, genuineness, and empathy) to allow the pts needs to be met
1. respect: acceptance of pts as they are (unconditional positive regard).Means to find a way to work with a pt even when you have differing values
2. genuineness: to be honest about one’s role, the limit of their knowledge
3. empathy: the ability to accurately understand the pt’s experiences as if it were your own to communicate this understanding to the pt (ex: reflection)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is congruence?

A

the match between a counselor’s inner process and their outward response

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are examples of attending/physical attending behaviors?

A

Use of nonverbal behaviors more deliberately to communicate focus on the pt
head nodding, smiling, facing the pt

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are examples of active listening

A

indicating that you are paying attention
i see, uh huh, tell me more about, can you give me an example about what you mean by

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Give an example of open-ended questioning. What goal does it achieve

A

invites broad responses
how are you feeling about the info that we just went over

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Give an example of closed-ended questioning. What goal does it achieve

A

asks for yes/no answers or for specific details; does not encourage collaboration or elaboration
do you have children

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Give an example of rephrasing. What goal does it achieve

A

stating in your own words what the pt has just told you. Demonstrates that the pt is being listened to and reinforces for the pt that the counselor has understood their experience
Pt: so i just don’t know if he is going to disappear or what
Counselor: so, you don’t think he’s very committed to the relationship?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Give an example of reflecting. What goal does it achieve

A

repeating the last phrase of a pt’s statement in the form of a question; encourages the pt to amplify their feelings or observations
pt: so that’s my decision- a mastectomy is better than cancer
counselor: better than cancer?
pt: well sure, that way i don’t have to worry any more

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Give an example of redirecting. What goal does it achieve

A

direct the intro and flow of topics or to refocus the pt when they’ve gone off on a tangent
that’s an important issue, but first I’d like to get back to; we will get to that, but I think it would be helpful to first hear about

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is a psychological assessment in a counseling session

A

ongoing process that helps to identify a pt’s assets (strengths, resources)
may include: support systems, financial resources, educational level, emotional capability, etc.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the main components of case prep

A

obtain family/medical hx
seek info on the genetic condition
perform a risk assessment (for pt and other family members)
determine if lab studies, evals, and referrals are indicated
obtain info about support/advocacy groups
formulate a plan for the clinic visit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Who is authorized to release medical records to other providers or the pt themselves

A

pt
parent (if the pt is a minor)
legal guardian (need documentation of guardianship)
next of kin (if deceased)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the steps to a RA

A
  1. determine genetic etiology (Mendelian/not? consider heterogeneity, gonadal mosaicism, de novo changes)
  2. evaluate pedigree (consider penetrance, variable expressivity, anticipation, possibility of non-paternity)
  3. perform RA (derive risks on patterns of inheritance, obtain empiric risks if non-Mendelian)
  4. Perform Bayes analysis (if indicated)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is one method to show chromosomal rearrangements to a pt

A

exchanging pen caps or rearranging letters to show an inversion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What should be DISCUSSed in pre-test counseling

A

D ecisions (will healthcare and life decisions change)
I nsurance implications
S ensitivity and other test parameters
C osts
U ses and limitations of test results
S ibs and other relatives at risk
S upportive resources

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is the bare minimum info you need when contacting a pt’s insurance company

A

pt’s policy info, test codes, and cost

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Why is insurance coverage for genetic testing for Medicaid pts difficult

A

Generally labs will only accept Medicaid from pts who reside in their state (ex: if lab is in Michigan, only Michigan Medicaid pts will be covered)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

When should DNA banking be considered

A

if the pt or family member has a genetic condition with a limited lifespan AND
genetic testing is unavailable
testing is available but has a low detection rate/is unaffordable
testing was done with no mutation identified
especially impt if pt is participating in research since provided samples will likely be inaccessible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What are the goals of rapport building

A

“what brings you into genetics”: know the pts circumstances and experience to form a relational context for the session
mutual expectations and goals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is confidentiality and boundaries in the clinical setting

A

defined as safeguards that do not impinge on pt autonomy, self-expression, confidentiality, and physical safety

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Who is Seymour Kessler and what did he describe

A

Defined nondirectiveness as “procedures aimed at promoting the autonomy and self-directedness of the client”

promoted when there is a decision-making climate through information, empathetic attachment, and professional guidance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Define empathy

A

the capacity to understand what another person is experiencing from w/in the other person’s frame of reference
it is essential to recognize a disruption or anticipate the impact of a counselor’s inattention, or the session may shift and empathetic attunement may be dropped

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What are the disruptions that can occur in the working alliance

A

Transference, countertransference, empathetic break

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Define transference

A

when a pt brings old patterns of expectations to new situations in attempt to create familiar structure for the event
challenge for the gc is not to unconsciously respond to the counselee’s transference

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Define countertransference

A

counselor’s rxn to the counselee’s story, her defenses and emotions or transference

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Define associative countertransference

A

when a pt shares an experience, loss, wish, or story that carries the counselor into their inner self

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Define projection

A

type of countertransference in which a counselor has made assumptions about a pt’s experience based on personal, parallel experiences

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Define projective identification

A

Occurs when a situation is extremely challenging to the counselee and they are not able to bring forward adequate psychological defenses to respond

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Define empathetic break

A

a shift or change in the interpersonal dynamics or what feels like a loss of focus that usually signals a disruption or loss of an empathetic connection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Describe this psychologically challenging experience: denial

A

inability to acknowledge to oneself certain info or news, and is common when the info elicits shock and fear

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Describe this psychologically challenging experience: anger

A

complex and universal experience that seeks to blame; in its most extreme form, there can be a wish to achieve revenge

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Describe this psychologically challenging experience: guilt

A

pts who hold themselves responsible for what they perceive as a negative outcome; will try to correct this with self-blame, rationalizations, or other intellectualizations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Describe this psychologically challenging experience: shame

A

pts offer the opportunity to appreciate the events that have placed a “burden of the self”. Attempt to reduce the psychological challenges to the self by means of denial and withdrawal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Describe this psychologically challenging experience: grief and despair

A

common responses to loss or anticipated loss. Unexpected “loss” often results in feelings of shock, anger, yearning, and sadness which can be experienced in phases or concurrently

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Describe this coping mechanism: confronting

A

trying to change the opinion of the person in charge

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Describe this coping mechanism: distancing

A

going on as if nothing has happened

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Describe this coping mechanism: self-controlling

A

keeping feelings to oneself

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Describe this coping mechanism: seeking social support

A

engaging in conversation in the hope of learning more

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Describe this coping mechanism: accepting responsibility

A

criticizing oneself

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Describe this coping mechanism: escape-avoidance

A

hoping for a miracle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Describe this coping mechanism: planning

A

identifying and and following an action plan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Describe this coping mechanism: positive reappraisal

A

identifying existing or potential positive outcomes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What is the goal of discussing coping mechanisms with pts

A

asking the pt how they have managed other difficult situations brings awareness to the coping strategy since it may be required for assisting the counselee in the experience that triggered the response

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What are the four tenets of gcing that ensure a safe psychological environment

A

the relationship must be integral to gcing
pt autonomy must be supported
pts are resilient
pt emotions make a difference

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Who is Carl Rogers and what did he describe

A

pioneered a form of psychotherapy described as “nondirective”, “client-centered”, or “person centered”
argued that for change to occur, 3 attitudes need to exist in the therapeutic relationship

nondirective approach places a high value on the right of every individual to be psychologically independent and to maintain their psychological integrity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What are the three components of Carl Rogers theory on non-directiveness

A
  1. genuineness; 2. empathetic understanding; 3. unconditional positive regard
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

What are Heinz Kohut’s contributions to counseling

A

convinced that the early childhood relational context w the parent or caregiver forms the structure of the self
can be useful in anticipating responses to difficult news and eval of suicide ideation
offer evidence that the counselor’s commitment to empathetic listening and understanding can lead to a more effective experience

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

What are Miller’s contributions to counseling

A

argued that the development of self emerges from the relational interactions with early caregivers and later with others in adult life
de-emphasis of individuation and separation as psychological requirements for ego formation. The ability to respond to critical life events can be influenced by the level of connectedness w self and others
psychological vulnerabilities can be reduced through a process that explores connectedness through empathetic attunement and mutuality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

What is the Family Systems theory

A

familial resilience theory is based on a deep conviction in the potential for family recovery and growth out of adversity
in genetics, often face resilience through adaptation, info, and family cohesion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Describe the three common family therapy models

A
  1. strategic approach: rooted in the work of Milton H Erickson and Jay Haley which states that the therapist determines corrective actions with the goal of changing behavior in the family system
  2. structural approach: Salvador Minuchin argued that families respond to stressors through the support of interfamilial boundaries and the arrangement of power
  3. Multigenerational approach: Murray Bowen described interlocking concepts that include differentiation of the self, family dynamics, and emotions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Describe the strategic approach in the family therapy model

A

rooted in the work of Milton H Erickson and Jay Haley which states that the therapist determines corrective actions with the goal of changing behavior in the family system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Describe the structural approach in the family therapy model

A

Salvador Minuchin argued that families respond to stressors through the support of interfamilial boundaries and the arrangement of power

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Describe the multigenerational approach in the family therapy model

A

Murray Bowen described interlocking concepts that include differentiation of the self, family dynamics, and emotions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Describe the family systems illness model

A

provides perspective on the interactive processes of psychosocial demand of the illness, family beliefs, and family functioning
inclusion of belief systems is essential to effective coping and adaptation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

What is NSGC’s definition of genetic counseling and what are the three components that are essential to expertise

A

the process of helping people understand and adapt to the medical, psychological, and familial implications of genetic contributions to dz

  1. we know something beneficial, 2. we know it well, 3. we are prepared to convey it through an instructional process
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

What are the four characteristics of a skilled and motivated instructor according to Wlodkowski

A

expertise, empathy, enthusiasm, and clarity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Define empathy in terms of a characteristic of a skilled and motivated instructor

A

counselor must have realistic understanding of pts needs and expectations in addition to providing info in a context appropriate for the pt’s level of experience

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Define enthusiasm in terms of a characteristic of a skilled and motivated instructor

A

demonstrates commitment to the topic w appropriate degrees of emotion, animation and energy, which in turn motivates the learner

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Define clarity in terms of a characteristic of a skilled and motivated instructor

A

language used and how it’s organized to ensure that the counselee can comprehend the info being presented

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

What did Malcom Knowles suggest of adult education

A

the learner is self-directed and their experience becomes a resource to be used, valued, and accepted

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Define proneness

A

lay beliefs about inheritance, and the nature and extent to which people feel prone to a genetic dz or feel that other FMs are subject to have or acquired the condition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

How should risk be communicated to pts

A

everyday words like “chance” and “likelihood” are more neutral
risk presentation must be balanced, accurate, and tailored to the pt (give a risk for the chances the complication will occur and a risk for the chances the complication will not occur)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Define objective and subjective risk estimates

A

objective: understanding risk figures numerically
subjective: understanding risk figures in their own interpretations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Define the availability Heuristic, give an example

A

actual or dramatic instances of certain outcomes will increase the perceived likelihood that the outcome will occur
ex: if a pregnant person’s friend had a miscarriage after an invasive procedure, she is less likely to have a similar procedure done

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

Define representative Heuristic, give an example

A

a judgement of probability is made based on how well the items being judged match a prototype or idealized example
ex: probability of the birth of three girls in a row is lower than an assortment of girls + boys

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

What should providers do when giving bad news

A

parents prefer significantly more communication of info and feelings by their physician (physician to show caring, allow parents to talk, parents to show their own feelings)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

What should be considered about pt recall

A

pts forget almost half of what they are told
pt recall best what they are told first and what consider important
important info should be “categorized” or highlighted verbally (ex: I am going to tell you what we think your son has and what tests we want to perform)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

Define health literacy

A

represents the cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand, and use info in ways that promote and maintain good health
many pt education materials need to be written at an appropriate reading level (8th grade) but are not

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

How could you use visual aids to show deletions, translocations, or duplications? genes strung together on the chromosome or of linked DNA bases?

A

colored markers with interchangeable caps
colored pipe cleaners, colored paper clips, beads on a string

fractions are preferred over %; pictures are most helpful

80
Q

Describe the health belief model of health education and promotion

A

attempts to explain and predict health-related behavior in the context of certain belief patterns
takes into account a person’s perception of the susceptibility and severity of the condition and the practical and psychological costs and perceived barriers to taking a “health” action

81
Q

Define self efficacy

A

confidence in a person’s ability to take action

82
Q

Describe the stages of change model of health education and promotion

A

views behavior as a circular process in which people do not change chronic and habitual behaviors all at once, but continuously through a series of stages
precontemplation –> contemplation –> decision –> action –> maintenance

83
Q

Describe the consumer information processing theory of health education and promotion

A

can be used to examine why people use or fail to use health information in their decision-making and hence can be instructional in the design and development of intervention strategies

84
Q

Describe factors impacting risk communication

A

internalization and retention of info, overestimation of risk, perceptions of risk, preference for risk information, fear, anxiety, and uncertainty

85
Q

What are are some factors that effect perceptions of risk

A

seriousness of disorder, beliefs about etiology, prognosis, and management, stress, familial experience with the condition, discussions in the genetic counseling session, level/accuracy of knowledge, personal attributes

86
Q

What is the typical preference for giving risk information

A

risk in gambling odds (1 in X) resulted in the most accurate estimate of risk and the preferred method by women with an increased risk for breast cancer

87
Q

Define the following factor that can influence perception of risk: anchoring

A

bias introduced by first concept or risk figure introduced
ex:
counselor: the risk of having another child with DS is low
client: so it won’t happen again?
counselor: the risk is only about 1%. how does that sound to you
client: well…low…i guess

88
Q

Define the following factor that can influence perception of risk: cognitive and emotional factors

A

individual factors like optimism vs pessimism, attitudes toward taking risks, preference for numerical format

client: I’m not too worried about the result. I doubt that I have it
counselor: you sound optimistic. have you thought about how you would react if the test showed that you inherited the mutation that your mother has

89
Q

Define the following factor that can influence perception of risk: prior beliefs

A

client beliefs about level of risk

counselor: now that we have a dx, we can tell you that the chance of Jamie’s condition happening again is 25%
client: wow, you’re kidding
counselor: it sounds like that surprised you. Is 25% lower or higher than you were thinking
client: well, my family doctor told me it’s one in a million! I think it’s probably lower than 25% and I’m not that worried

90
Q

Define the following factor that can influence perception of risk: availability

A

prior experiences of a pt

client: what if I have a miscarriage? my neighbor had an amnio, and she miscarried one week later
counselor: it can really hit you hard when you know somebody that had a complication. Let’s talk a little about our overall experience at St. Mary’s

91
Q

Define the following factor that can influence perception of risk: representativeness

A

interference from small sample to a larger group

client: I don’t seen how the risk can be 50%. In my family everybody has it!
counselor: let’s take a closer look. We know that 4 of the women in your parents’ generation had breast cancer, but we don’t really know about the men because they are unlikely to develop cancer if they inherit the mutation. One of your aunts died at a young age, so we also don’t know if she had the mutation. Since the women in your generation are young, we don’t know their experience. When we look at a whole group of families, we see that about 50% of people inherit BRCA mutations when their parent has a mutation. We think that having more than 50% in one family is just random chance. That’s why I think your chance is still 50%. I can see why you feel that the risk is higher. If your test results come back negative, do you think you’ll believe the result?
client: I…don’t know

92
Q

Define the following factor that can influence perception of risk: complexity

A

complexity of risk figures

client: I’m confused. You said that my risk is 50% to have the mutation and 30% to develop cancer if I have it? How much should I worry about it?
counselor: Let’s take a look at it using some pictures. It may help you to visualize it better

93
Q

Define the following factor that can influence perception of risk: competing values

A

competing values and responsibilities

client: I don’t feel like I could lose another baby like that again, but I’ve always wanted to have a big family

94
Q

Define the following factor that can influence perception of risk: binarization

A

tendency to view risk in two categories (it will or will not occur)

counselor: the risk of having another child with OI is 5%. How does that number sound to you?
client: Well, it happened before and my risk was much lower. To me it seems like 50-50. Either you have it or you don’t

95
Q

Define the following factor that can influence perception of risk: uncertainty

A

uncertainty associated with the risk figure

client: you mean I could get Mom’s mutation and never even have cancer!

96
Q

Define the following factor that can influence perception of risk: math ability

A

ability to understand numerical values and probability

client: Since I have two children with it already, that means I should have two without it, right?

97
Q

Define the following factor that can influence perception of risk: consequences

A

range of consequences for a specific client

counselor: we talked about the full range of fragile X syndrome and that it is hard to predict the symptoms for another baby
client: That’s what’s so hard about this decision. We know we don’t want to bring a boy into the world with problems like my nephew, but we wouldn’t be sure how bad it would be

98
Q

Define the following factor that can influence perception of risk: need for uncertainty reduction

A

emotional need to reduce uncertainty

client: I just want to know. I’m so sick of wondering, will I have it or not? Nothing could be worse than that!
counselor: If you were to test positive, what do you think would change for you?

99
Q

Define the following factor that can influence perception of risk: risk vs. burden

A

Concept of risk vs burden in light of the concepts of uncertainty and undesirability

counselor: it sounds like you don’t know what to do. How do you think your life would change if you had a child with hemophilia?
client: Well, I know the risk is pretty high. But I’ve seen how my mom handled it, and I think our family did pretty well

100
Q

Describe the three principles of risk communication

A
  1. assess a priori beliefs, knowledge, preferences, expectations, anxiety, and coping strategies before formulating a risk communication plan
  2. prioritize info to be given. put info in context and use multiple communication strategies/formats
  3. f/u w materials (leaflets, personal letters). consider more than one meeting
101
Q

How would you incorporate risk communication in a family

A

use a team approach to encourage the use of genetic services, identifying a family leader in the process
assess and use relational info to identify family members who may be influential and supportive to counseling and testing decisions, as well as persons who may be barriers to the diffusion of info

102
Q

What are some factors that impact decision making

A
  1. the possibility of effective prevention, tx, or screening
  2. health beliefs (perceived risks, beliefs about etiology)
  3. characteristics of the counselee (age, coping mechanisms, etc.)
  4. concerns about potential risks
103
Q

What is the decisional conflict scale

A

designed to measure the level of decisional conflict experienced by pts making health care decisions

104
Q

What is non-directiveness? What does it accomplish?

A

procedures promoting the autonomy and self-directedness of the pt
aims to raise pt self esteem and leaves them w greater control over their lives/decision
is an ACTIVE process

105
Q

What are some considerations that counselors need to make concerning the testing of children and young adults for late onset disorders OR carrier status of a recessive chromosomal disorder

A
  1. child loses their future autonomy as an adult to make their own informed decision
  2. child loses the right to confidentiality
  3. there is potential negative impact of testing and the test result on the child’s upbringing
106
Q

What are the three most important reasons for recording medical info

A
  1. ensure the best care for the individual and family
  2. document events of outpt/inpt vist
  3. facilitate communication among HCPs
107
Q

What are the federal and medicare/medicaid regulations for medical documentation

A

federal regulations require providers participating in medicare to ensure that medical records are “accurate, promptly completed, filed, retained, and are easily accessible”

regulations pertaining to medicare are developed by the CMS, which also dictates federal program requirements for Medicaid (often held as the standard for all healthcare providers and payers)

108
Q

When should medical documentation occur?

A

must occur within 15d of hospital discharge per Medicare
changes after the initial documentation should be clear and legible

109
Q

What are some recommendations for medical documentation

A

should be objective and factual. Preferable to be as brief as possible.
source and date of additional medical info should be documented
phrases such as “the pt denied” and “the pt reported” convey the pt was asked about an issue and a specific response was given
ages and years of birth only of FMs are not protected under HIPPA

110
Q

What is the bare minimum documentation you need to disclose information in the medical records? If someone is deceased, what do you need?

A

authorization is adequate when pt completes a form with: identify info, specific info being requested, purpose in which the info may be disclosed, to whom the info is being sent, authorization expiration date (if applicable), pt’s signature

if the pt is deceased, letter of authority (given to the executor of a person’s estate by the probate court upon their death) AND the signed request is needed

111
Q

What is a CPT code? What are the common ones GCs use?

A

describes type and duration of services provided. Published annually by the American Medical Association

For GCs, code is 96040; also can use 98966-98969 for telephone and online counseling sessions

112
Q

What is a hospital rule about retaining records under Medicare requirements

A

all hospitals that participate in Medicare must retain records for a minimum of 5yrs

info containing tax/financial records should be retained a minimum of 3yrs for income tax audit purposes

113
Q

What regulations do HCPs and other agencies that receive Medicaid/Medicare have to undergo regarding medical documentation

A

required to participate in external quality review programs by professional review organizations (PRO)

use medical documentation to determine if appropriate practice parameters were adhered to, or investigate fraudulent/abusive billing practices

114
Q

What does the multicultural counseling approach entail

A

encourages immigrant groups to keep their traditions, even celebrate them and share them with others as a way of enriching society as a whole

115
Q

Define cultural code

A

a set of values or beliefs and assumptions, notions that shape the way people from diverse cultures act and think, relate and communicate; what they consider right or wrong, good or bad, sacred or profane, important or unimportant

116
Q

What is the biomedical model of medicine

A

illness and disabilities seen as the result of biophysical or mechanical causes

117
Q

What is the macro-religious model of medicine

A

disease and disorders are a result of divine intervention, which can serve as a form of punishment or an act of grace, or acts of spiritual powers that seek to do harm

118
Q

Define culture

A

a group of people’s total way of life: the way they act and think, organize themselves, relate and communicate, make or build things, express feelings and emotions, and respond to the world

remember: culture is learned and logical; we can use this to our advantage in a counseling session to gain insight into our pts values and beliefs

119
Q

What are the four core American values that have been documented to have the greatest effect on the relationship btwn HCPs and pts from diverse backgrounds

A
  1. individualism
  2. egalitarianism
  3. time and task orientation
  4. masculinity
120
Q

Describe individualism and how it relates to the medical system

A

disabilities and disorders are experienced as individual problems requiring individual action

121
Q

Describe collectivism and how it relates to the medical system

A

decision making does not lie with the individual but with the group of which they are a part of

122
Q

Describe egalitarianism and how it relates to the medical system

A

everyone should be tx the same and should have equal opportunities for achievements and success

123
Q

Describe authoritarianism/hierarchical thinking and how it relates to the medical system

A

clear distinctions between higher and lower classes, between superior and inferior status or position

124
Q

Describe reciprocity and how it relates to the medical system

A

ppl will respond to intimate questions only when the person asking them first shares some of their own experiences; common in authoritarian settings

125
Q

What is the holistic model of medicine

A

people assume and seek to maintain a sense of balance or harmony between human beings and their physical, social, and spiritual environments

illnesses are seen and experienced as a brokenness in the harmony and balance between all things seen and unseen

126
Q

Pts of other cultural backgrounds than their counselor have only ___% of effective communication

A

20-25

127
Q

What are the three levels of communication? Define them

A
  1. cognitive level: primarily uses verbal, uses rational arguments, is based in facts, and appeals to people’s understanding and mental assent
  2. evaluative level: refers to the way in which pts evaluate their counselor (first impressions): their expertise, trustworthiness, and reliability
  3. Relational level: establish a bond with the pt
128
Q

What are features of low context cultures

A

communication is direct and to the point, brief and focused

129
Q

What are features of high context cultures

A

communication is indirect and implicit, people talk around the subject and embellish the point

130
Q

What is identification

A

the willingness to put yourself in your pts’ shoes and walk in them for a while

131
Q

Define morality

A

a community of people with common code of conduct, an agreed upon view of what is acceptable behavior and what behavior is not acceptable
the goal of moral behavior is to decrease the harms suffered by members of society

132
Q

What are ethics

A

establishment of a set of guidelines for morally acceptable conduct within a theoretical framework

133
Q

What are principles

A

source of guidelines for behavior. From principles, values are drawn and rules developed.

134
Q

Define values

A

qualities that are considered good or priorities, and are desirable and important

135
Q

Define rules

A

specific guides that must be followed at all times

promote and protect basic human interests, both individual and societal

136
Q

Define ideals

A

goals with which we aspire

137
Q

Define duties

A

behaviors that are defined by our professional role or social role

138
Q

Define virtues

A

morally or socially desirable characteristics

139
Q

Define rights

A

justified claims

140
Q

Ethical theory: consequence based utilitarianism

A

promotion of happiness
actions that maximize good and promote the greatest amount of happiness > pain are acceptable actions
resolve dilemmas by looking at the consequences of doing or not doing an action

141
Q

Ethical theory: virtue ethics

A

focuses on character traits/virtues a good person should have
resolve dilemmas by asking how a virtuous person would act in that situation

142
Q

Ethical theory: principle based ethics

A

core principles of autonomy, justice, maleficence, and beneficence
resolve dilemmas by weighing competing principles, duties, and values

143
Q

Ethical theory: ethic of care

A

focused on the humanistic virtues (sympathy, compassion, fidelity, discernment, love), those characteristics that are valued in interactive, intimate relationships
resolve dilemmas by promoting respect for equality while recognizing and valuing differences

144
Q

Define beneficence. How does fidelity relate

A

promotion of personal well being in others
when benefits are balanced against harms and costs, the outcome should be a net benefit
provider and pt are assumed to have similar values and views

fidelity requires the provider not to withdraw from a pt’s care without notice to the pt, to submerge their own self-interests if they are in conflict with the pt’s (candor, loyalty, and integrity are derived from this principal

145
Q

Define non-maleficence

A

restrictions on behavior as opposed to actions that promote behavior (do no harm)
typically raised by the use of people of subjects in research/testing experimental therapies

146
Q

Define autonomy. What are the principles that are derived from this?

A

represents the individual’s personal rule of self, the need to remain free from controlling interference that may prevent an individual’s making of meaningful choices

truth telling, confidentiality, informed consent

147
Q

Define truth telling in the context of autonomy

A

related to the obligations of fidelity and promise keeping that are inherent in the medical relationship; also pertains to the management/info that can affect one’s understanding/decision making

148
Q

Define confidentiality in the context of autonomy

A

relates to the communication between people and the fact that a relationship exists between them

main difference between confidentiality and privacy: privacy relates to limited or restricted access to an INDIVIDUAL

confidentiality can be waived by the pt

149
Q

Define informed consent in the context of autonomy

A

a pt’s autonomy is manifested in their right to make their own healthcare decisions including declining tx
the threshold element is competence, the capacity to make a rational choice

150
Q

What are the elements of informed consent

A
  1. COMPETENCY
  2. info: amount and accuracy- disclosure of possible benefits/risks of an intervention, obligation to discuss available alternatives
  3. pt understanding- obligation of the provider to identify barriers of informed consent and overcome them
  4. consent, including voluntary authorization
151
Q

Define justice

A

implies fairness, equitability, and appropriate tx. Four values are recognized as justice
1. equality: equal care for all
2. liberty: freedom of choice
3. excellence: best possible care for all
4. efficiency: containment of costs

152
Q

What are four questions you should ask yourself to determine if a situation is ethical

A

Are the pts’s rights being protected and harm is not coming to the patient? (Beneficence)
Are we avoiding harming the pt or putting them at risk? (Nonmaleficence)
Are we respecting the pt’s right to be self-determining?(Autonomy)
Are we tx pts fairly, equitably, and appropriately? (Justice)

153
Q

What is a code of ethics

A

the moral obligations deduced from the kinds of activity in which the members of the profession are engaged. An enforceable code lists those duties that are required, with penalties for failure to perform them

154
Q

What are the goals of the NSGC code of ethics

A

does not put forth rules to follow but offers guides for the pursuit of the ideals, therefore is NOT an enforceable document
written from the ethic of care perspective, which is defined by interpersonal relationships

155
Q

What is included in section 1 of the NSGC code of ethics

A

genetic counselors and themselves
value competence, integrity, veracity, dignity, and self-respect in themselves and others. Goals:

always be prepared, maintain current knowledge, standards of practice- legal docs/guidelines for pt expectations, accurately represent our training and skills to others, take care of oneself physically and mentally

156
Q

What is included in section 2 of the NSGC code of ethics

A

GCs and their patients
value care and respect for the pt’s autonomy, individuality, welfare, and freedom
appropriate, efficient, and prompt services are necessary for the pt to be able to exercise their decision-making rights; honesty and candor necessitate self-awareness in terms of ethical and moral standards, confidentiality for the pt during the session and beyond; we need to be reminded that overcharging, providing unnecessary services, and profiting in any way from pt info or property is unacceptable

157
Q

What is included in section 3 of the NSGC code of ethics

A

GCs and their collages
based on mutual respect, caring, cooperation, and support.

peer support is valuable for promoting relationships with others in the profession, respect for other professionals naturally leads to promotion of the goals of quality services, support and care about trainees, appropriate professional and personal boundaries must be recognized

158
Q

What is included in section 4 of the NSGC code of ethics

A

GCs and society
interest and participation in activities that have the purpose of promoting the well-being of society and access to healthcare

need to keep up to date with the science of genetics, and with how, when, and where this information is presented to the public; encompasses the principle of Justice, work within the laws and regulations of society

159
Q

What is the implications of violations on rights in terms of legal issues

A

rights can be violated or infringed upon

a violation is UNjustified while an infringement IS justified

160
Q

What did the privacy act of 1974 establish

A

limits the disclosure of info obtained by employees of federal services, federal agencies, and government contractors

161
Q

What did the rehabilitation act of 1973/civil rights statutes establish

A

prohibit the infringement of a person’s rights by private entities involved in employment, housing, or public accommodations on the basis of race or sex

162
Q

What did the ADA of 1990 establish

A

adds disabilities to the characteristics described in the civil rights statues and extends it to cover private businesses

employers CANNOT take genetic info into account when making a job offer

163
Q

What did HIPPA of 1996 establish?

A

prohibits group health plans from denying individuals coverage based on genetic info and using such info to justify charging such persons higher premiums

includes requirements for EMR transactions
GCs are “covered entities” under HIPPA
for areas regulated by both the federal and state governments, a state may be stricter than the federal government but not more lenient

164
Q

When are parents allowed to make decisions for their children? When can they be superseded by HCPs?

A

since parents have direct sovereignty over minor children, they are entitled to make decisions on behalf of their offspring
a parent may consent to therapy or decline it, but CANNOT refuse life saving therapy for a child

165
Q

How can the clinical diagnosis of Silver Russell syndrome be established

A

Must have at least four of the following clinical criteria, two of which must be relative macrocephaly at birth and frontal bossing/prominent forehead; other disorders with growth restriction must also be ruled out:

small for gestational age
postnatal growth failure (at age 24mo)
relative macrocephaly at birth
frontal bossing/prominent forehead
body asymmetry
feeding difficulties

166
Q

How is the molecular diagnosis of Silver Russell syndrome established

A

abnormal methylation of chrom 11p15.5
Mat UPD of chrom 7, chrom 11, and chrom 16
Pathogenic mat GOF variants in CDKN1C
Pathogenic pat LOF variants in IGF2, PLAG1, or HMGA2

167
Q

What are the tired approaches to testing for Silver Russell syndrome

A

first tier: methylation analysis of 11p15.5 imprinting control regions (ICR1/ICR2) (35-67%) and upd(7)mat SIMULTANEOUSLY (7-10%)

second tier: multigene panel including sequence analysis of IGF2, CDKN1C, PLAG1, HMGA2

Other: SNP CMA to identify chromosomal dels, dups, isodisomy; methylation analysis of chroms 11 and 16 to detect SRS due to upd(11)mat and upd(16)mat

168
Q

Describe the growth, feeding, and gastro features seen in pts with Silver Russell syndrome

A

most children are born small for GA, rarely show significant catch-up growth
goals GH treatment improving growth velocity, body composition, psychomotor development, and appetite, as well as reducing the risk of hypoglycemia and optimizing overall linear growth

GH deficiency is not common, but tx should be indicated regardless of the presence or absence of GH deficiency

little subcutaneous fat, poor appetite, oral motor issues, and feeding disorders; at risk for hypoglycemia; GERD, esophagitis, oral aversion, vomiting, constipation, FTT

169
Q

Describe the skeletal, craniofacial, dental, neurodevelopmental and GU features seen in pts with Silver Russell syndrome

A

limb length asymmetry, fifth finger clinodactyly or brachydactyly, scoliosis; monitor for signs of premature adrenarche, early and accelerated puberty, and insulin resistance
Pierre Robin sequence and cleft palate, bifid uvula; microdontia, high arched palate, dental crowding secondary to relative micrognathia, overbite and dental crowding
increased risk for developmental delays including motor, cognitive and speech delays
hypospadias and cryptorchidism in males; underdeveloped or absent vagina and uterus with normal appearance of the external genitalia in females

CHDs are uncommon- can be in the form of PDA, VSDs, TOF

170
Q

What specialists should someone with Silver Russell syndrome be referred to

A

endocrinologist, gastroenterologist, dietician, clinical geneticist, craniofacial team, orthopedic surgeon, neurologist, speech language therapist, and psychologist

171
Q

How should the manifestations of Silver Russell syndrome be tx

A

growth abnormalities: early referral to endo and consider GH therapy
hypoglycemia: frequent feeding, avoidance of prolonged fasting between feeds, monitor for urinary ketones
endocrine: personalized tx w GnRH for at least 2yrs in children w evidence of central puberty, can be considered to preserve adult height potential
GI/feeding difficulties: enteral feeding with gastrostomy or jejunostomy tube for extreme cases of feeding aversion and/or GERD
skeletal abnormalities: early referral to orthopedic sx for management of limb length discrepancy and scoliosis
craniofacial anomalies: early referral to craniofacial expert for severe micrognathia, cleft palate, and/or dental anomalies
GU anomalies: referral to urologist for children w hypospadias and/or cryptorchidism

172
Q

What testing should be done on probands/parents with hypomethylation on ICR1 or CDKN1C/IGF2 PV for a pt for a accurate recurrence risk

A

Silver Russell syndrome

hypomethylation at ICR1 on pat chrom: SNP CMA to detect underlying CNVs, cyto analysis to detect larger dups in the 11p15.5 region; if genetic alteration identified in proband, parents should undergo same testing; sibs risk can be at high at 50% depending on fragment size

proband with CDKN1C/IGF2 PV: molecular genetic testing of the parents for PV identified in the proband FH may appear negative due to sex limited penetrance; 50%risk to sibs if mom has CDKN1C PV and 50% if dad has IGF2 PV

173
Q

What is the recurrence risk for a proband with somatic mosaicism for upd(11)mat in the offspring

A

presumed to be low since imprint normally resets in the germline

174
Q

What testing should be done on probands/parents with upd(7)mat or HMGA2/PLAG1 PV for a pt for a accurate recurrence risk

A

Silver Russell syndrome

most upd(7)mat is de novo although rarely there is a predisposing genetic alteration: CNV in the critical imprinted region (pat inherited del or mat inherited dup in 7q32, recurrence risk 50%) or a translocation involving chrom 7
proband should have SNP CMA/cyto analysis and if there is an alteration identified parents should have the same

Proband with PV in HMGA2/PLAG1 should have molecular testing with parents and if there is a del in HMGA2/PLAG1, do SNP CMA for proband and parents (recurrence risk is 50% for sibs)

175
Q

What prenatal testing CANNOT be done for Silver Russel syndrome

A

reliable prenatal analysis for loss of paternal methylation at the 11p15.5 ICR1 H19/IGF2 region is not possible

176
Q

What are the four elements that must be proven for malpractice? What is malpractice?

A

The misuse of information, failure to recognize a genetic disorder, misdx, ordering of a wrong test, not taking a FH) is a tort action
1. there was a provider-pt relationship and a DUTY owed by the defendant to the plaintiff
2. the defendant BREACHED that duty either by failure to act or deviation from the standard of care
3. the breach of the duty was the direct CAUSE of the harm suffered by the plaintiff
4. An actual INJURY (physical, financial, emotional) resulted, which can be compensated for by the courts

177
Q

What ethical and legal concerns come with sex selection

A

American society for reproductive medicine relaxed its opposition to sperm-sorting if the technique is used for the purpose of family balancing (discourages the use of PGD for sex selection)
ACOG opposes providing sex selection for personal and family reasons bc the use could be seen as a form of sexism

178
Q

What ethical and legal concerns come with presymptomatic testing in children

A

the testing of a child cannot be justified for disorders in which symptoms are rare in childhood and for which no tx is available

179
Q

What ethical and legal concerns come with GINA/ADA

A

Included in the definition of disability under the ADA are ppl with a genetic predisposition and those who are asymptomatic carriers of a late-onset disorder
insurance companies are regulated by the states

180
Q

What ethical and legal concerns come with the duty to warn 3rd parties

A

the duty to prevent harm may at times, limit the professional’s duty of confidentiality
in the infrequent circumstance that there will be great harm, a provider can override the pt’s confidentiality after 1st informing the pt
disclosing pt health info is now regulated by the privacy rule of HIPPA (obtaining pt consent for such disclosure is required, with only a very few specific exceptions)

181
Q

What ethical and legal concerns come with unexpected findings

A

the first considerations include the relevance of the info to the pt’s situation and the consequences of the findings
arguments for disclosing incidental findings are based on the principle for respect for autonomy
ASHG 1996 recommended that FMs not be informed when nonpaternity is discovered unless paternity was the purpose of the testing. HOWEVER, facts relevant to medical decision making cannot be justifiably withheld

182
Q

What ethical and legal concerns come with duty to recontact

A

usually the duty a professional owes a pt lasts as long as there is a need for the professional’s services (Ex: duration of an illness)
Bc the PCP has an ongoing relationship with the pt, he should be responsible for reminding the pt to keep in touch with a genetics HCP for changes in the field that may affect their care
not clear how far back in time the duty to recontact would apply

183
Q

What are the goals for supervision

A
  1. promote professional development of student supervisors
  2. ensure continued provision of quality pt services
  3. serving a gate keeping function regarding those who enter the profession

helps students develop and gain increased awareness of ethical issues and their resolution, develop greater awareness of their professional blind spots, and become socialized to the profession

184
Q

What is the point of goal setting

A

aims or expectations regarding the skills that a student is expected to achieve and provide a framework for supervision

185
Q

What is the Discrimination model of classifying student skills

A

classifies student skills into four categories
1. process skills: “doing skills” that consist of the actual techniques and strategies used in a gc session
2. professional skills: “doing skills” that involve adherence to professional standards of behavior, including adherence to ethical standards of the profession
3. personalization skills: “feeling skills” that pertain to the internal, subjective rxns students have toward their pts, toward gcing, and toward their supervision relationships
4. conceptualization skills: “thinking skills” that involve cognitive process such as case analysis and pt conceptualization

186
Q

What is Bloom’s taxonomy? Describe each level

A

consists of hierarchy of learning processes from basic memorization of facts to highly sophisticated critical thinking

Knowledge level: students repeat what they have learned from their classes
Comprehension level: students demonstrate their understanding of what generally is intended to accomplish in a gcing session and why it is important by explaining reasons for pointing out discrepancies to pts
Application level: students identify what might be appropriate for a particular type of pt and demonstrate in a role play how they would approach such a pt
Analysis level: students identify aspects of a pt’s situation they would want to challenge as well as factors that might promote or hinder a session with a pt
Synthesis level: students connect their responses to pt goals by articulating how a particular pt’s inconsistent behavior helps the pt make the best decision for themself
Eval level: students judge the effectiveness of their approaches to meet its intended goal for a given pt and provide evidence to support their assessment

187
Q

Describe this supervisor-student role: the teaching role

A

primary interaction is instruction (demonstrating, explaining, and interpreting events from GC sessions)
focus on developing student’s skills as a GC

188
Q

Describe this supervisor-student role: the consultation role

A

mutually agreed upon objectives, encourages the student to self-evaluate, focus of supervision is on the student’s pts
consultant acts as a facilitator who works with the consultee to determine effective planning and action

189
Q

Describe this supervisor-student role: the counseling role

A

goal is to promote self-awareness and growth
supervisor assists the student to recognize developmental tasks and become aware of personal issues that may affect responses to pts

190
Q

Describe this supervisor-student role: the evaluation role

A

primary goal is critiquing and feedback giving with a focus on accountability

191
Q

What is evidence based medicine

A

an approach to healthcare that promotes the collection, interpretation, and integration of valid, important, and applicable pt-reported, clinician observed, and research-derived evidence

192
Q

What are subjective experiences

A

one’s thinking is conditioned by one’s previous experiences, educational background, discipline of study, philosophy, and social heritage

193
Q

What are objective experiences

A

in research, working to understand a topic in a way that does not introduce the researcher’s own interests and perspectives
should be reproducible with similar or same outcome

194
Q

Describe the features of a qualitative study

A

aim: complete, detailed description
useful in early stages of project development
need to only roughly know what you’re looking for
design emerges as study unfolds
researcher= gathering data instrument
data= words, pictures, objects
richer data, more time consuming, less generalizable, researchers more subjectively immersed in subject matter

195
Q

Describe the features of a quantitative study

A

aim: classification, counting, and construction of stat models to explain observations
useful in later stages of project
researcher knows what they are looking for
all aspects of study are designed before data are collected
uses questionnaires for numerical data
data are more efficient and more generalizable
researchers more objectively separated from subject matter

196
Q

What is a human subject

A

any living individual or fetus about whom a research investigator obtains data via interaction or intervention

also includes human tissue
does NOT include deceased individuals and research on them –> NOT protected by IRB regulations
research conducted on individuals participating in public behavior is also not regulated by the IRB
IRB review process is geared toward minimizing potential risks and maximizing benefits

197
Q

What are the categories for CEUs

A

Category 1: granted for programs with content targeted to GCs and pre-approved by NSGC
Category 2: available for programs approved by organizations other than NSGC for CEUs

ABGC will approve CEUs for supervision, publications, outreach, presentations, teaching, etc.

198
Q

Describe the four main domains of genetic counseling skils

A
  1. communication skills: requires communication of complex, emotionally laden, and technical info
  2. critical thinking skills: major role of GCs is sifting through large amounts of info and resources and analyzing what info is most critical to the case
  3. interpersonal, counseling, and psychosocial assessment skills: using these skills in a meeting will enable one to have a better understanding of verbal and nonverbal cues that may impede communication or reaching an agreement
  4. professional ethics and values

Board Review 2024 (29 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions