Inclusive genetic counseling for <scp>LGBTQ</scp> + clients: A qualitative study of reproductive genetic counselors' experiences and perspectives

The availability of assisted reproductive technologies has enabled the lesbian, gay, bisexual, transgender, queer, and other marginalized sexual orientations and gender identities (LGBTQ+) community to pursue reproductive healthcare services for family planning, including genetic testing and counseling. However, this group often encounters obstacles to equitable reproductive care related to discrimination, and genetic counselors (GCs) often feel underprepared to support LGBTQ+ clients. Limited literature exists on the interactions between reproductive GCs and LGBTQ+ clients, indicating a need for better understanding of how GCs can provide effective care to LGBTQ+ individuals seeking reproductive services. Using a semi-structured interview guide, we conducted in-depth interviews with 17 GCs practicing in preconception and/or prenatal genetics to examine their experiences and practices of LGBTQ+ inclusivity. Interviews were transcribed, coded, and thematically analyzed to identify broader patterns. Four thematic categories were produced in the reflexive thematic coding process: (1) obstacles for LGBTQ+ clients in navigating reproductive genetics; (2) challenges and opportunities experienced by GCs regarding LGBTQ+ inclusivity; (3) counseling strategies used by GCs to provide LGBTQ-inclusive care, as well as challenges and motivations in incorporating such strategies; and (4) the importance of LGBTQ+ topics in graduate training and continuing education in shaping GC practices of LGBTQ+ inclusivity. The results illustrate that although GCs recognize the impact of anti-LGBTQ+ discrimination on their clients and counseling, they and other providers often experience difficulties or reluctance with implementing LGBTQ-inclusive practices. Additionally, while participants described using various LGBTQ-inclusive counseling strategies, inconsistency and insufficient training in such practices suggest there is a need for meaningful continuing education on LGBTQ+ topics. These findings underscore the value of broad applications of LGBTQ-inclusive counseling in reproductive genetics, as well as the importance of continuing education to promote LGBTQ+ inclusivity and strengthen inclusive counseling skills.