Individuation and implicit racial bias in genetic counseling communication

Patient Educ Couns. 2020 Apr;103(4):804-810. doi: 10.1016/j.pec.2019.10.016. Epub 2019 Nov 8.


Objectives: Genetic counselors (GCs) can frame information in either general terms (i.e., population risks) or individual terms (i.e., tailoring to specific client characteristics). We investigated whether informational framing might reflect GCs' implicit racial bias.

Methods: We analyzed previously videotaped genetic counseling sessions with white and minority (Black and Latino) simulated clients (SCs) and modeled the relationship between sixty GCs' implicit racial bias, as measured by the Implicit Association Test (IAT), and informational framing (general or individual) as characterized by the Roter Interaction Analysis System.

Results: Higher (more pro-white) IAT scores predicted less informational individuation for minority relative to white SCs. Similarly, higher IAT predicted fewer facilitation and activation statements to minority relative to white SCs. With higher IAT-scoring GCs, minority SCs disclosed less psychosocial and lifestyle information, and asked fewer medical questions (all p < 0.05).

Conclusion: GCs' racial implicit bias may be associated with less individualized communication style when counseling minority clients.

Practice implications: Future research should address whether increasing informational individuation can ameliorate negative consequences of implicit bias and help providers reframe perceptions of minority patients in individual rather than categorical terms.

Keywords: Genetic counseling; Implicit attitudes; Individuation; Patient-provider communication; RIAS; Race/ethnicity.

Publication types

  • Research Support, N.I.H., Intramural

MeSH terms

  • Communication
  • Genetic Counseling*
  • Humans
  • Individuation*
  • Racism*
  • White People