Assessing the need for certainty in users of a clinical genetic health service

This paper presents a study investigating the need for closure in users of a genetic health service.

Genetic healthcare services are used by people who are concerned about a genetic condition in the family. Many clients expect information about the condition, risk assessment and discussion of options available to minimize the impact of the condition on the family. Some use the information to try to obtain certainty or cognitive closure. The psychological theory termed 'need for cognitive closure' explains individual differences in motivation to seek information. The tendency to seek closure can be measured by the Need for Closure Scale, which has five sub-scales: preference for order, preference for predictability, discomfort with ambiguity, decisiveness and closed-mindedness.

Clients who were referred to our genetic service in 1998 were approached before personal contact with staff of the genetic service. Fifty-two people completed the need for closure scale questionnaire. Six months after the genetic consultation, participants were asked to complete the questionnaire again (n = 45). The data were statistically analysed using Cronbach's alpha, paired t-tests and independent t-tests.

There were no statistically significant differences in Need for Closure Scale scores in this cohort before and after the genetic consultation. Participants scored highly on the preference for order and discomfort with ambiguity sub-scales, but scores for closed-mindedness were low. Intolerance of ambiguity was statistically significantly higher in participants whose main concerns centred on their children.

This psychological theory can help healthcare professionals to understand the motivation of clients who seek information from genetic services, and enhance understanding of those who avoid using the service. It cannot be assumed that additional knowledge is helpful to all clients, nor that knowledge of bad news is necessarily an adverse event if prior uncertainty has existed.