A Tool for Ethical Analysis of Persuasion and Influence in Genetic Counseling Communication

Background: As genetic counseling is incorporated into medical settings where genetic results influence health recommendations, the traditional ethos of “non-directiveness” becomes increasingly inadequate to address the range of clinical uses of genetic information. Whether and to what extent deliberate influence and persuasion should play larger roles in genetic counseling is an underexplored question. Historically, genetics professionals have been hesitant to embrace influential communication as an ethically justifiable component of genetic counseling. Deliberate and unintentional forms of influence used are poorly characterized and their ethical implications are unclear. While most agree that persuasive communication should be ethically justified, patient-centered, and equitable, there has been limited conceptual and empirical investigation into what this should look like in clinical communication.

Objective: The objective of our project is to develop a framework and coding system to describe and evaluate providers’ and patients’ uses of influential communication in genetic counseling sessions .

Methods: Work is underway to create a framework for identifying influential communication strategies based on a review of empirical studies and conceptual literature. We will develop a coding system to apply this framework to transcripts from 138 standardized genetic counseling encounters. In this session, we will describe the findings from this analysis and discuss their normative implications.
Implications: This work is an initial step towards developing an evidence-based approach to describe uses of influence reliably and consistently in genetic counseling. We intend for our approach to be applicable to empirical and normative clinical communication research in both genetic counseling and other clinical settings.

Leila Jamal – National Cancer Institute – National Institutes of Health; Debra Roter – Health, Behavior & Society – Johns Hopkins University; Mary Catherine Beach – General Internal Medicine – Johns Hopkins University