Applying the practice-based competencies to evaluate and characterize the contracting process within genetic...

Area of Science:

• Medical Genetics
• Genetic Counseling
• Health Communication

Background:

• Contracting is a crucial skill for genetic counselors (GCs) to establish shared session goals and enhance patient autonomy.
• While described in practice-based competencies (PBCs), the systematic observation of contracting skills in genetic counseling has been limited.
• Understanding the practical application of contracting is essential for improving patient-centered care.

Purpose of the Study:

• To systematically evaluate the use and quality of contracting skills employed by genetic counselors during simulated sessions.
• To identify specific components of contracting as defined by PBCs and explore potential additional elements present in practice.
• To provide an empirical basis for assessing genetic counselor performance in the contracting phase of genetic counseling.

Main Methods:

• Directed content analysis of 148 transcripts from simulated prenatal and cancer genetic counseling sessions.
• Development and pilot testing of a codebook and rating scale based on four PBC-defined contracting skills.
• Independent coding and rating of transcripts by three authors, with discrepancies resolved through consensus.

Main Results:

• The four PBC-defined contracting skills were present in 88%-98% of the analyzed sessions.
• Genetic counselors generally received 'adequate' scores for the observed contracting skills.
• Three additional contracting components were identified: assessing client concerns met, inviting interruptions, and including partner concerns.

Conclusions:

• The study provides the first evaluation of genetic counselor performance on a PBC during a counseling session.
• The findings validate the relevance of PBC sample contracting skills in actual genetic counseling practice.
• The identified additional components offer opportunities to refine and expand the understanding of effective genetic counseling contracting.