Butow and Lobb (2004) conducted a major study, examining in detail the process and content of genetic counselling in initial consultations with women from high-risk breast cancer families. Over 158 consultations of women unaffected and affected with breast cancer, conducted in 10 familial breast cancer clinics throughout Australia, were audiotaped and transcribed. A detailed coding system was developed to cover all facts thought to be important to be elicited from or conveyed to the consultant, and all behaviours thought to facilitate active involvement and expression of emotional concerns.
This analysis evidenced that the average genetic counselling session was 61 min [comparable to that of European clinics (Hopwood et al. 2003a)], that patients spoke on average one-third of the session and consultants demonstrated consistently good practice in providing detailed information on essential aspects related to familial breast cancer. The authors noted that, although the woman's agenda was frequently elicited, other subjects were tackled less frequently, namely the women's decision to discuss the results with other family members or emotional concerns such as those relating to prior experiences of loss and grief. Considering the predominant role played by information processing in cancer genetic counselling, it has to be stressed that passive listening reduces understanding and interactivity should therefore be stimulated. Moreover, training in or self-monitoring of behaviours known to facilitate understanding (checking women's medical knowledge, checking understanding, explaining medical terms, inviting questions, summarizing, and using diagrams) may assist clinical geneticists and genetic counsellors to further develop these skills.
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