The impact of genetic counselors' use of facilitative strategies on cognitive and emotional processing of genetic risk disclosure for Alzheimer's disease

Yue Guan; Debra L Roter; Jennifer L Wolff; Laura N Gitlin; Kurt D Christensen; J Scott Roberts; Robert C Green; Lori H Erby

doi:10.1016/j.pec.2017.11.019

The impact of genetic counselors' use of facilitative strategies on cognitive and emotional processing of genetic risk disclosure for Alzheimer's disease

Patient Educ Couns. 2018 May;101(5):817-823. doi: 10.1016/j.pec.2017.11.019. Epub 2017 Nov 27.

Authors

Yue Guan¹, Debra L Roter², Jennifer L Wolff³, Laura N Gitlin⁴, Kurt D Christensen⁵, J Scott Roberts⁶, Robert C Green⁷, Lori H Erby⁸

Affiliations

¹ Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA. Electronic address: yguan@som.umaryland.edu.
² Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
³ Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
⁴ Department of Community Public Health, School of Nursing, Center for Innovative Care in Aging, Johns Hopkins University, Baltimore, MD, USA.
⁵ Division of Genetics, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
⁶ Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA.
⁷ Division of Genetics, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Broad Institute of MIT and Harvard, Cambridge, MA, USA; Partners Personalized Medicine, Boston, MA, USA.
⁸ Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA.

Abstract

Objectives: To determine the impact of genetic counselor (GC) communication on cognitive and emotional processing of Alzheimer's disease (AD) risk information during discussions with patients with clinical diagnoses of mild cognitive impairment and their companion.

Methods: 79 recordings and transcripts of AD risk disclosure sessions collected as part of the fourth REVEAL Trial were coded using the Roter Interaction Analysis System (RIAS) and the Linguistic Inquiry Word Count (LIWC). Multilevel analyses were used to determine the association between GCs' use of communication facilitation strategies and patient and companion use of words indicative of cognitive and emotional processing.

Results: GC used somewhat more cognitive (14%) than emotional (10%) facilitation strategies. Both patients and companions used more words indicative of cognitive (18% and 17%) than emotional (6% and 5%) processing. GC use of facilitative strategies and patient and companion use of cognitive and emotional processing words were significantly associated in both unadjusted and adjusted models (all p-values<0.01).

Conclusions: GCs' use of facilitative strategies assist in cognitive and emotional processing in a way that may be linked to therapeutic benefit.

Practice implications: These findings highlight mechanisms through which GCs may assist patients and companions to better understand and cope with risk information.

Keywords: Alzheimer’s disease; Genetic counseling; Genetic testing; Patient–provider communication; Social cognitive processing; Visit companion.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Adult
Aged
Aged, 80 and over
Alzheimer Disease / diagnosis
Alzheimer Disease / genetics*
Cognition*
Cognitive Dysfunction / diagnosis*
Communication*
Counselors / psychology*
Disclosure*
Emotions*
Family / psychology*
Female
Genetic Counseling / methods*
Genetic Counseling / psychology
Genetic Predisposition to Disease
Humans
Male
Middle Aged
Office Visits
Professional-Patient Relations*

Abstract

Publication types

MeSH terms

Grants and funding