Pilot Study of the Process of Prenatal Genetic Counseling

This study will examine the process of prenatal genetic counseling to determine how various client and counselor factors affect the communication process in a counseling session. The specific aims of the study are to: * Provide information on prenatal genetic counselors' interactions with clients for the basis of a future larger study of the genetic counseling process. * Determine the average length and the range of length of prenatal genetic counselors' interactions with clients when family history information has already been provided. * Document on videotape the communication content and interaction dynamics of prenatal genetic counselors interacting with clients in order to: * Characterize different models of prenatal genetic counseling * Determine the nature of discussions concerning cystic fibrosis carrier testing within the context of prenatal genetic counseling. * Examine the impact of prenatal genetic counselors' characteristics (years of experience, training and background, age, clinical setting, anxiety) on the communication content and interaction dynamics of sessions with clients. * Examine the impact of the presence of a spouse on the communication content and interaction dynamics of prenatal genetic counseling sessions with clients. * Examine the impact of client verbal emotional cues on the communication content and interaction dynamics of prenatal genetic counseling sessions. Counselors will be recruited for this study from among practicing prenatal genetic counselors at regional meetings and a national meeting of the National Society of Genetic Counselors. They will perform prenatal genetic counseling sessions with actors in the roles of client and client's spouse. The sessions will be videotaped, and the counselor and actors will fill out questionnaires regarding the characteristics of the counselor and the session. Counselors may be contacted later to request permission to use segments of their videotaped sessions for creating a video teaching tool for counseling professionals that illustrates different ways to practice the genetic counseling.

The main objective of this pilot study is to provide insight into the process of prenatal genetic counseling that can both inform the practice of prenatal genetic counseling and serve as the springboard to a later, more comprehensive study. The research participants will all be practicing prenatal genetic counselors recruited from regional meetings and a national meeting of the National Society of Genetic Counselors. Participating genetic counselors will be asked to perform a prenatal genetic counseling session with a simulated client (an actor) or simulated clients (actor and actor posing as spouse) presenting with the indication of advanced maternal age. The participating genetic counselors will also be asked to address cystic fibrosis carrier testing within the course of this session. This session will be videotaped. In addition, both the genetic counselor and simulated client will be asked to fill out questionnaires related to characteristics of the counselor and the session itself. The process and content of the genetic counseling communication will be analyzed qualitatively and quantitatively (using Roter Interaction Analysis System). Through these analyses, we hope to both describe the nature of prenatal genetic counseling communication in a relatively large sample and to determine the ways in which a variety of client and counselor factors affect the communication process itself (determined through changes in the RIAS communication codes). In addition, we hope to provide information on the logistics of data collection in order to inform a similar larger study planned to look at the impact of communication on client outcomes.