Data at baseline and a videotape recording of the initial visit were available for analysis for 130 counselees ().
Details of inclusion of counselees.
In , relevant counselee characteristics are listed. The counselees with a family history of cancer had one to four (M=1.5, s.d.=0.8) first-degree and one to eight (M=2.1, s.d.=1.5) second-degree affected relatives. Participants were, on average, 2.1 years older than decliners (P
=0.022) (Pieterse et al, 2005
); however they did not differ in gender, referral pathway, type of cancer, or (family) history of cancer.
Counselee demographics, history of cancer, and course of counselling
Five clinical geneticists (four female, one male), four residents in clinical genetics (three female, one male), and five genetic nurses (all female) participated. Counsellors were aged 29–46 years (M=38.1, s.d.=5.3).
Consultations lasted 43.9
min (s.d.=13.7) on average. The counsellors conducted 93 visits out of 130 (72%) alone. During the 37 visits out of 130 that were conducted by a clinical geneticist together with a resident or a nurse, the counsellor with the largest amount of utterances averaged 468.4 statements (s.d.=162.9; min.=199, max.=821), compared to a mean of 138.5 utterances by the other counsellor (s.d.=85.5; min.=6, max.=369). Moreover, in 29 (78%) of these 37 visits, the former spoke at least two times more than the latter. In 63 of the 130 (48%) visits, counselees were seen alone. During all other consultations, counselees were accompanied by one (N
=61) or two or more individuals (N
=6). Utterances of companions added up to 6.7% of the total communication ().
Mean and percentagea of occurrence of the various coding categories (N=130 visits)
Counselee and counsellor conversational contribution
On average, 19% of counselee and 14% of counsellor communication related to socio-emotional communication, mainly (16.8. vs 11.4%) indications of acknowledgment or agreement ().
Task-oriented communication consisted largely of counselees providing information (17.5%) and counsellors informing and educating counselees (21.0%). The counselees mainly provided information on their family history of cancer, medical condition, and pedigree, adding up to 26% of counselee talk (not in the table). They further essentially provided information on their agenda and on psychosocial issues, each category adding up to 6% of counselee talk. The counsellors asked counselees about their agenda in 123 of the 130 visits and the counselees provided information on their agenda in 129 of the 130 visits. The counsellors mostly provided information on general or counselee-related medical issues, as well as medical advices for counselees and their relatives, utterances that amounted to 33% of counsellor talk (not in the table).
The counselees contributed significantly less to the interaction than the counsellors, a mean of 40 vs 53% utterances (paired t=11.8, P=0.000). In particular, counsellors asked significantly more questions (3.7 vs 0.6%; paired t=17.45, P=0.000) and made significantly more orienting or directive remarks (5.8 vs 1.0%; paired t=19.84, P=0.000). The counsellors also used significantly more paraphrases (7.9 vs 2.1%; paired t=19.47, P=0.000), thereby confirming shared understanding and knowledge. This included summaries of family history of cancer, information that the counsellor gathered from the counselee prior to or during the visit. The counselees had a significantly stronger psychosocial focus than counsellors (paired t=−10.57, P=0.000).
Topics covered during the visit
Overall, the counselees' motives for and referral pathway to counselling were almost always a topic of discussion, in contrast to their risk perceptions ().
Frequencies (%) of discussing topics during the initial visit
Also, predisposition to cancer and possibilities, limitations, and procedure of DNA testing were discussed in a majority of visits. Medical consequences of testing were discussed in more than half and emotional consequences in less than half of the visits. In 79–99% of the visits, the counsellor initiated the discussion of a topic, except for emotional consequences of DNA testing, where counsellors took the initiative in just over half (31 out of 53; 59%) of the visits in which it was discussed (not in the table).
Indication for DNA testing and whether the initial visit would be the only one or not did not affect the frequency of discussing reasons for encounter. With counselees for whom DNA testing was indicated, mode of inheritance and meaning of genetic predisposition were discussed significantly more often compared to those without an indication (P=0.015 and 0.040, respectively), as well as possibilities (P=0.001), procedure (P=0.000), and medical consequences of testing (P=0.043). Compared to those who would be seen again, how often the type of cancer is genetic and procedure of DNA testing were discussed less often with counselees for whom the initial visit was the only visit (P=0.009 and 0.001, respectively).
Influence of previsit needs on counselee communication
Previsit needs slightly affected counselee communication in that there was a trend for counselees considering it more important to receive explanations on the assessment of cancer susceptibility to ask more medical questions (B=0.20, χ2=3.74, P=0.053) and those attaching more weight to be taken seriously and be listened to carefully, to provide more information on their agenda (B=0.14, χ2=2.98, P=0.084).
Influence of previsit needs on counsellor communication
The counselees' previsit needs affected counsellor communication in that counsellors provided more psychosocial information and education to counselees who had higher previsit needs for emotional support (B=0.21, χ2=4.29, P=0.038).