Journal of Genetic Counseling最新文献

{"title":"Interpreter use in telehealth genetic counseling sessions","authors":"Laura Karina Padilla,&nbsp;Priscila Delgado Hodges,&nbsp;Charité Ricker,&nbsp;Jennifer L. Geurts","doi":"10.1002/jgc4.2026","DOIUrl":"https://doi.org/10.1002/jgc4.2026","url":null,"abstract":"<p>Patients in the United States with Limited English Proficiency (LEP) lack access to language-concordant genetic counselors. This places patients with LEP at a disadvantage during appointments due to previously identified factors such as time constraints, lack of formal training for genetic counselors, and interpreters' limited training in genetics terminology. When done well, interpretation services enhance healthcare and expand access to genetic counseling. Given the increased utilization of telehealth for the delivery of genetic counseling services including telephone and video communication, it is imperative to adapt practices to avoid exacerbating disparities among underserved communities. This qualitative study explores strategies used by experienced genetic counselors (GCs) in telehealth sessions with interpreters. Participants were board-certified GCs and had high-volume of patients with LEP seen via telehealth. Semi-structured interviews (<i>n</i> = 11) were conducted virtually and recorded. Interviews were coded for themes using descriptive coding. Development of the codebook was done with study team members reviewing 1–2 transcripts against the initial codebook for feedback. Codes and the codebook were refined through an iterative process. Thematic analysis revealed two major themes: how GCs gained their knowledge, and strategies GCs used during interpreted telehealth appointments. Experienced GCs gained their knowledge through on-the-job experience, learning from interpreters, and from bilingual colleagues. Results also indicated that when providing services over telehealth for patients with LEP, experienced GCs employ strategies to overcome difficulties in educating, assessing patient understanding, and meeting psychosocial needs. These strategies build on GC core competencies and best practices for working with interpreters to adapt for telehealth delivery. As such, this study offers practical guidance for GCs and trainees with suggestions before, during, and after an interpreted telehealth appointment. GCs can make strides for equity in the quality of telehealth sessions for patients regardless of language by leveraging these insights, learning about the cultures of the communities they frequently serve, and willingness to adapt sessions.</p>","PeriodicalId":54829,"journal":{"name":"Journal of Genetic Counseling","volume":"34 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgc4.2026","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143761957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Decision stability among adolescents and young adults making choices about learning genomic research results","authors":"Amy A. Blumling,&nbsp;Holly Elder,&nbsp;Jessica A. Sinclair,&nbsp;Srimayi Mulukutla,&nbsp;Madeline Mahoney,&nbsp;Cynthia A. Prows,&nbsp;Melanie F. Myers,&nbsp;Michelle L. McGowan","doi":"10.1002/jgc4.2010","DOIUrl":"https://doi.org/10.1002/jgc4.2010","url":null,"abstract":"<p>With increasing opportunities for minors to undergo genomic testing, factors influencing young people's decision stability and instability regarding genomic testing are unclear. This interpretive description study examines decision stability when adolescents (13–17) and young adults (18–21) decide whether to learn genetic testing results. Adolescents and young adults enrolled in a clinical trial chose whether they wanted to learn genetic testing results and could modify their decisions during a study visit or 2 weeks later. A purposive sample of clinical trial participants was invited to participate in an interview exploring their decision preferences, confidence level, and factors impacting decision stability. Twenty-two participants chose to learn all (<i>n</i> = 7), some (<i>n</i> = 7), or no genetic test results (<i>n</i> = 8). Perceptions of the impact of personal genetic information on one's quality of life and sense of reproductive goals and responsibilities were driving factors for people who chose to learn no or some genetic results, while curiosity influenced those who chose to learn all. Prior health and healthcare experiences and others' influence also factored into decision-making about receiving results. Decision stability varied among individuals but increased over time and was positively influenced by parents, baseline decision confidence, and fear of missing out on the opportunity to learn genetic information. Participants felt favorably about the opportunity to change their decision 2 weeks after the study visit. Among study participants, decision stability was high, as was satisfaction with decisions regarding how much personal genetic information to learn. The results suggest that adolescent and young adult genetic research participants may experience high decision stability and confidence in making choices regarding personal genetic testing, especially when a window of opportunity for change is available. Researchers and clinicians should consider the benefits and challenges of offering multiple checkpoints to bolster decision stability.</p>","PeriodicalId":54829,"journal":{"name":"Journal of Genetic Counseling","volume":"34 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgc4.2010","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143761958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An exploration of delegation practices regarding the utilization of genetic counseling assistants for disclosure of genetic testing results","authors":"David Ranson,&nbsp;Camille O. Allison,&nbsp;Leah Wetherill,&nbsp;Paula R. Delk,&nbsp;Kristyne Stone","doi":"10.1002/jgc4.2015","DOIUrl":"https://doi.org/10.1002/jgc4.2015","url":null,"abstract":"<p>Genetic counselors (GCs) play a crucial role in the healthcare system, providing education, support and guidance regarding genetic risk assessment, testing and results interpretation. To help GCs practice at the highest level of their expertise, the role of the genetic counseling assistant (GCA) was introduced, focusing on tasks like administrative support and patient care coordination. Although GCs typically handle the disclosure of test results, there is limited research on the delegation of results disclosure to GCAs. This study explores GCs' perspectives on delegating negative and variant of uncertain significance (VUS) genetic test results disclosures to GCAs. A quantitative survey was conducted among GCs practicing in the United States and Canada. Results revealed that while the majority of GCs were willing to delegate both negative and VUS results, few currently do so. Oncology GCs exhibited greater willingness and actual delegation of VUS disclosures relative to other specialties. Effective communication skills, level of genetics knowledge, and willingness to seek help were identified as the most influential attributes on GCs' confidence in GCAs' abilities to disclose test results. The most frequent concern about GCAs disclosing negative and VUS results was remaining suspicion for an underlying genetic etiology. Additionally, GCs were concerned about delegating VUS disclosures since patients more frequently struggle to understand those results. A triaging system to determine suitable results for a GCA to disclose and extensive shadowing of GCs disclosing results were proposed as methods of building GCs' confidence in the ability of a GCA to disclose test results. Ultimately, a better understanding of the discrepancy between GCs' willingness to delegate results disclosures and actual delegation practices is essential if the GCA scope of practice were to include results disclosure.</p>","PeriodicalId":54829,"journal":{"name":"Journal of Genetic Counseling","volume":"34 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgc4.2015","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143762076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prenatal genetic counseling challenges with indeterminate SMA results","authors":"Molly Spangenberg,&nbsp;Laura Godfrey Hendon,&nbsp;Dana H. Goodloe,&nbsp;Fallon Brewer,&nbsp;Guihua Zhai,&nbsp;Alicia Gomes","doi":"10.1002/jgc4.2017","DOIUrl":"https://doi.org/10.1002/jgc4.2017","url":null,"abstract":"<p>Spinal muscular atrophy (SMA) is an autosomal recessive neuromuscular condition with complex genetic etiology. About 95% of individuals affected with this condition have a homozygous deletion of the <i>SMN1</i> gene. One scenario that complicates risk is when a parent is identified as a possible silent carrier, meaning they have a [2 + 0] chromosome configuration. This configuration occurs when an individual has two copies of the <i>SMN1</i> gene on one chromosome and no copies on the other chromosome. It is thought that 3.8–4.0% of the general population is a [2 + 0] carrier with a higher prevalence in African American and Hispanic populations. The [2 + 0] configuration makes it more difficult to calculate residual risk because testing cannot determine the difference between [2 + 0] carriers and [1 + 1] non-carriers, leading to indeterminate SMA carrier screening results. SMA was added to general population carrier screening in 2017, leading to an increase in the number of patients identified to have indeterminate results. Previous research has not examined how this addition has affected counseling practices involving indeterminate results. The purpose of this research was to gain a better understanding of the practices and challenges in this area, specifically within non-Ashkenazi Jewish (AJ) populations. This study utilized a quantitative survey with open-response questions. Responses from 49 prenatal genetic counselors from the United States and Canada were analyzed and it was found that genetic counselors face similar challenges when counseling indeterminate SMA results across all regions. These include negative patient emotions and both patient and referring provider misunderstanding, as highlighted in the qualitative data. Three major categories emerged including (1) challenges with patients, (2) challenges with referring providers, and (3) the effects of the 2017 addition to general population carrier screening. This study highlights the need for provider education surrounding indeterminate SMA results, the development of a visual aid, and future research from the patient and referring provider perspective.</p>","PeriodicalId":54829,"journal":{"name":"Journal of Genetic Counseling","volume":"34 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgc4.2017","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143762070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unveiling genetic counseling skills: Developing an online training course and analyzing counselor communication practices","authors":"Deborah L. Cragun,&nbsp;Mariah Volesky,&nbsp;Tanner Scott,&nbsp;David Cline,&nbsp;Nila Khan,&nbsp;Mason Holum,&nbsp;Elena Fisher,&nbsp;Amelia Richardson,&nbsp;Lou Clark PhD, MFA,&nbsp;Kalli-Ann Binkowski,&nbsp;Asim Imtiaz,&nbsp;Heather A. Zierhut","doi":"10.1002/jgc4.2002","DOIUrl":"https://doi.org/10.1002/jgc4.2002","url":null,"abstract":"<p>Despite the pivotal role of communication skills in genetic counseling, communication strategies employed by genetic counselors in their current practice remain largely unexplored. The field of genetic counseling could benefit from updated simulated genetic counseling sessions conducted by genetic counselors illustrating a diversity of skills. This paper outlines the development and evaluation of updated simulations used to develop an online training course to identify genetic counseling skills and to assess how commonly these skills are used. Practicing genetic counselors in the United States were recruited to counsel trained standardized patients across six pretest and posttest simulated sessions in cancer, prenatal, and cardiology genetics settings. Sessions were coded using the novel Genetic Counseling Skills Checklist to identify which communication and counseling skills were utilized. Standardized patients were asked to provide session quality ratings and written feedback, which were analyzed using descriptive statistics and content analysis, respectively. Results from 64 recorded sessions involving 20 counselors from a variety of training programs, racial and ethnic backgrounds, states of residence, and with varying years of clinical experience revealed utilization of a broad array of skills across specialty types and clinical indications. The total number of unique skills used varied widely from 12 to 49, with an average of 35.8 out of 56 possible skills checked per session. Differences in skill usage were observed between pretest and posttest sessions. Standardized patient comments were predominantly positive with a focus on information delivery and empathetic responses. Perceptions of areas of improvement were giving less information, having clearer delivery, and expressing more empathy. This work led to the creation of a training course showcasing various skills used by practicing genetic counselors, which summarizes commonly used skills and other promising but less frequently utilized ones.</p>","PeriodicalId":54829,"journal":{"name":"Journal of Genetic Counseling","volume":"34 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgc4.2002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143689614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Addressing United States government censorship as related to genetic counseling research in the Journal of Genetic Counseling","authors":"Nadine Channaoui,&nbsp;Kimberly Zayhowski,&nbsp;Jehannine (J9) Austin","doi":"10.1002/jgc4.70029","DOIUrl":"10.1002/jgc4.70029","url":null,"abstract":"","PeriodicalId":54829,"journal":{"name":"Journal of Genetic Counseling","volume":"34 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143676935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to: Practice resource-focused revision: Standardized pedigree nomenclature update centered on sex and gender inclusivity: A practice resource of the National Society of Genetic Counselors","authors":"Kathryn Steinhaus French,&nbsp;Robin Bennett,&nbsp;Robert Resta","doi":"10.1002/jgc4.2020","DOIUrl":"10.1002/jgc4.2020","url":null,"abstract":"<p>Bennett, R. L., French, K. S., Resta, R. G., &amp; Austin, J. (2022). Practice resource-focused revision: Standardized pedigree nomenclature update centered on sex and gender inclusivity: A practice resource of the National Society of Genetic Counselors. <i>Journal of Genetic Counseling</i>, <i>31</i>(6), 1238–1248. https://doi.org/10.1002/jgc4.1621.</p><p>As per Rathbun and Paulyson Nuñez (Rathbun &amp; Paulyson Nuñez, <span>in press</span>) and our Reply to Rathbun and Paulyson Nuñez (French et al., <span>in press</span>), we inaccurately and interchangeably used the terms “surrogate” and “gestational carrier” in our previous publication (Bennett et al., <span>2022</span> Figure 5 examples 3 and 4). A “gestational carrier” is defined as a person who carries a pregnancy resulting from the transfer of a preimplantation embryo, but who has no genetic relationship with the embryo. The term “surrogate” is defined as a person who donates eggs <i>and</i> carries the pregnancy for another. We have updated our recommendations accordingly (see Figure 5).</p><p>We now suggest removing the symbol for surrogate “S” (Bennett et al., <span>2022</span>, Figure 5 example 3) and instead using the gestational carrier symbol “G.” We also recommend adding a “G” to the circle on the right to indicate a gestational carrier in the 2022 article, Figure 5, example 5 (see corrected Figure 5, example 4). This can clarify some reproductively complex pedigrees. In addition, regarding Figure 5 example 5 from our 2022 article, we now recommend removing the “D” from the circle on the left, since this is an intended parent and not an egg donor.</p><p>In reviewing Figure 4 from our 2022 publication, we noted that the symbol for ectopic pregnancy was inconsistent with the 2008 guidelines (Bennett et al., <span>2008</span>, Figure 1); the forward slash was accidentally omitted. Our corrected Figure 4 reflects this change.</p><p>In our Correction, we amended the Figures to reflect the above changes and made some minor revisions to improve clarity (Figures 1-5).</p><p>In recognition of the continual evolution of language regarding reproduction and gender, we recommend regular review of this standardized pedigree nomenclature to align with rapidly changing definitions of reproduction and gender.</p><p>All authors contributed equally to the conception, writing and graphic design.</p>","PeriodicalId":54829,"journal":{"name":"Journal of Genetic Counseling","volume":"34 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11926493/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143671595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transgender and gender diverse patients' experiences with pregnancy-related genetics discussions: A qualitative study","authors":"Jaime Schechner,&nbsp;Kimberly Zayhowski,&nbsp;Darius Haghighat,&nbsp;Maggie Ruderman","doi":"10.1002/jgc4.2018","DOIUrl":"10.1002/jgc4.2018","url":null,"abstract":"<p>Reproductive healthcare experiences for transgender and gender diverse (TGD) individuals are often characterized by cisheteronormative biases and inadequate support. Despite growing recognition of the need for gender-inclusive care, there remains a dearth of research exploring TGD individuals' perspectives on pregnancy-related genetic discussions with healthcare providers. This study aimed to address this gap by investigating TGD individuals' experiences with pregnancy-related genetic discussions, focusing on the challenges they face and strategies for improving care. The study employed a qualitative approach, including demographic surveys and semi-structured interviews with questions centered on pregnancy-related genetic discussions, to gather data from 15 TGD participants. Data were analyzed using reflexive thematic analysis with a queer theoretical lens to identify key themes and insights. The findings revealed pervasive cisheteronormative biases in pregnancy-related genetics discussions, including providers misgendering patients during routine genetics explanations and conflation of sex and gender. Participants highlighted the lack of information on the effects of testosterone therapy on pregnancies and expressed discomfort in gendered clinic spaces. Participants advocated for gender-inclusive training for all healthcare staff and the adoption of affirming practices to create more inclusive healthcare environments. This study underscores the urgent need to address systemic biases and shortcomings in reproductive genetics healthcare for TGD individuals. By prioritizing gender-inclusive training and promoting affirming clinical environments, healthcare providers can work towards ensuring equitable access to reproductive and genetic healthcare for TGD patients.</p>","PeriodicalId":54829,"journal":{"name":"Journal of Genetic Counseling","volume":"34 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11923581/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lessons learned from BRCA1/2 screening in Israel: A cross-sectional survey comparing experiences and communication","authors":"Rotem Greenberg,&nbsp;Moran Echar,&nbsp;Amihood Singer,&nbsp;Lena Sagi-Dain","doi":"10.1002/jgc4.2014","DOIUrl":"10.1002/jgc4.2014","url":null,"abstract":"<p>This study aimed to evaluate the perceived quality of pre- and post-test explanations given to women carrying BRCA1/2 variants, and to compare these outcomes between two cohorts: female BRCA1/2 carriers identified through self-reported population-based screening (the screening group), in comparison to self-reported formal pre-test genetic counseling due to personal or familial cancer history (genetic counseling group). This cross-sectional survey of female BRCA1/2 carriers employed an anonymous questionnaire distributed through the “Good Genes – a support and information group for BRCA carriers” association from January to March 2023. Main evaluated outcomes included the perceived quality of pre- and post-test explanations, first analyzed in the overall cohort, and then compared between the 110 respondents in the screening group, to 444 women in the counseling group. In the screening group, 45.5% rated the perceived quality of pre-test explanations as unsatisfactory, compared to 27.4% in the genetic counseling group (<i>p</i> = 0.0005). In terms of result delivery, the screening group reported higher instances of inappropriate timing (61.8% vs. 40.3%, <i>p</i> &lt; 0.0001), suboptimal mode of delivery (55.5% vs. 37.5%, <i>p</i> = 0.0008) and suboptimal perceived quality in post-test explanations (51.4% vs. 33.9%, <i>p</i> = 0.0006), as well as elevated stress levels (74.3% vs. 64.3%, <i>p</i> = 0.043). In the screening group, 21.5% of the women reported that the results were communicated by phone, letter, or online notice, compared to 17.2% in the counseling group, a non-statistically significant difference. A logistic regression model controlling for timing and mode of delivery showed that both timing (<i>β</i> = 0.46, <i>p</i> &lt; 0.001) and mode of delivery (<i>β</i> = 0.39, <i>p</i> &lt; 0.001) remained significant predictors of dissatisfaction of post-test counseling. The findings of this survey underscore the pressing need for enhancements in pre-test explanation, as well as the post-test counseling for positive results, especially within the realm of BRCA screening.</p>","PeriodicalId":54829,"journal":{"name":"Journal of Genetic Counseling","volume":"34 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgc4.2014","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Toward a therapeutic relationship: A randomized control trial of the physical environment and client-centered communication in genetic counseling","authors":"Elizabeth Broadbridge,&nbsp;Debra L. Roter,&nbsp;Susan Persky,&nbsp;Lori H. Erby","doi":"10.1002/jgc4.2013","DOIUrl":"10.1002/jgc4.2013","url":null,"abstract":"<p>Genetic counselors routinely provide service in many environments, including counseling-type and medical-type rooms; in this study, counseling environments are characterized by office décor that facilitates discussion around a seated table, while medical environments include an exam table and separate seating. Outside of the genetic counseling context, manipulation of the environment can influence client comfort in disclosing personal information, well-being, and overall satisfaction with clinician communication. However, there is little known about how clients experience genetic counseling in one environment versus the other and how that might influence their evaluation of genetic counselor communication. To explore the extent to which the physical environment influences client perceptions, we video recorded two simulated sessions addressing the same genetic counseling topic with two contrasting styles of communication (more and less patient-centered) in front of a greenscreen background. Videos were digitally placed in counseling and medical environments such that the same verbal and nonverbal communication was presented in the two environments, creating a total of four videos (e.g., a 2 × 2 experimental design). Participants (<i>N</i> = 861) were randomly assigned to observe one of the four videos and respond as if they were the client in the video (e.g., as analog clients). Overall, participants rated the less patient-centered communication more favorably (<i>p</i> &lt; 0.05 across variables), contrary to our expectations. Structural equation modeling revealed that perceptions of nonverbal communication mediated the relationship between communication style and perceptions of the counselor's encouragement of participation in the session and the therapeutic bond. Results offer insight into how the physical environment might influence communication in genetic counseling, illustrating new avenues for improving client-counselor communication in this context.</p>","PeriodicalId":54829,"journal":{"name":"Journal of Genetic Counseling","volume":"34 2","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11923929/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}