Characterizing psychosocial assessments across genetic counseling sessions through qualitative content analysis

Although psychosocial support and assessment is a required competency of genetic counselors (GCs), how the psychosocial assessment is actualized in sessions is not well studied. We aimed to describe the landscape of psychosocial assessments in clinical genetic counseling sessions at a single institution through direct analysis of audio recordings. Clinical GCs at Stanford Medicine and their new English-speaking adult patients were eligible. After GCs and patients completed demographic surveys, we audio-recorded sessions for which the GCs and patients enrolled. Purposive sampling, prioritizing a breadth of GCs, specialties, indications, and patient demographics, was used to select audio recordings for transcription and analysis. We used a blended inductive and deductive approach to develop the codebook. Code frequency and memos were assessed for descriptive content analysis of psychosocial components of the sessions. We analyzed 23 audio recordings, representing nine GCs across cancer, cardiology, and prenatal. We identified three distinct psychosocial styles that GCs used: "Direct," "Informational," "Casual." While all styles incorporated emotion-focused conversation to some degree, only the "Direct Psychosocial Style" included an explicit psychosocial assessment of patients. Psychosocial assessments consisted of direct feelings questions, emotion-focused responses, and advanced empathy. The "Informational Psychosocial Style" was characterized by GC responses to patient feelings and sympathy statements, without consistent exploration of patient feelings throughout the session. The "Casual Psychosocial Style" was characterized by an observable rapport between the GC and patient that carried throughout the session, allowing for psychosocial issues to be explored organically. GCs varied in their use of each style across patients, specialty, and indication. In conclusion, we observed three distinct psychosocial styles, of which only the Direct Psychosocial Style had an overt psychosocial assessment. Further research is needed to examine patient outcomes within each style.