Enhancing Patient Engagement in Oncology-Specific Genetic Counseling: A Conversation Analytic Approach

Individuals referred for genetic counseling due to suspected hereditary cancer syndromes often face significant uncertainty and anxiety as they navigate complex emotions while making sense of unfamiliar genetic information. While effective communication is central to supporting patients in joint decision-making, empirical studies analyzing actual counseling sessions remain limited. This study explores how genetic counselors (GCs) in Singapore apply and adapt communication strategies in real-world scenarios to facilitate patient understanding and psychosocial support. Conversation analysis is used to identify interactional features of patient-centered care through analysis of video recordings of genetic counseling sessions. The findings show, first, that the formulation of the opening sequence appeared to influence the trajectory of the consultation. Open-format elicitations tended to encourage richer, patient-led narratives while closed-format openings were more likely to constrain responses and limit opportunities for patients to voice their views. Second, concerns about self or family were raised either spontaneously by the patient or in response to prompts by the clinician. The preparedness of GCs to engage patients at the psychosocial level, either by explicitly inviting patients to share their worries or concerns, or by latching onto patients' momentary revelations of personal circumstances and experiences, resulted in strengthened emotional support. Through microlevel analysis of interactional practices, this study extends existing genetic counseling literature by revealing how information giving is integrated with psychosocial support to facilitate patient engagement and informed decision-making. The findings offer evidence-based insights that enable practicing GCs to refine their skills and could also inform training programs.