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[Genetic counselling (results of ten years experience). IV. Attitude of persons seeking counselling and reliability of the counsel (author's transl)].

The authors, from their personal experience arising from 766 consultations, show that the percentages of marriages or procreations in subjects themselves suffering from a disorder, or with affected relatives, are independent of the risk estimated for their offspring. The procreation rate in couples with affected children is lower in high risk cases and depends also on the family composition. It appears that this procreation is voluntary in the great majority of cases because there were very few terminations of pregnancy among the couples seen before procreation. The estimated risks correspond to the risks observed but the authors insist that there is a relatively high proportion (4.4 per cent) of children born with a disorder different from that which motivated the consultation.

Abortion, Eugenic

No-red-tape counseling for clients alienated from traditional services. Walk-in counseling center. Minneapolis, Minnesota.

Since 1969 the Walk-In Counseling Center in Minneapolis has offered free, no-red tape counseling to individuals and families alienated from traditional services. All counseling is provided by teams of mental health professionals who volunteer their services. The emphasis is on crisis and short-term counseling with a maximum of ten sessions. The center was established mainly to serve young drug abusers, but the clientele has diversified to include individuals of all ages and socioeconomic groups. The center also conducts an active consultation and education program with more than 200 community groups a year.

Adolescent

"Practical suggestions on counseling how I do it": counseling the laryngectomized patient.

A laryngectomee's home environment may be a critical motivating factor for successful rehabilitation. Results from questionnaires to 45 wives of laryngectomees are discussed. The wives evaluated the adequacy of their preparation for the surgery and the type and severity of ensuing problems. Judgments as to the type and adequacy of counseling and the wives' factual understanding of the laryngectomy procedure and its consequences are reported. Results of the survey underscored the need for more counseling before and after laryngectomy. Wives of older laryngectomees were more optimistic post-operatively since their primary preoperative fear had been death. Younger wives' spirits are often lowest after surgery when the impact on daily living was more fully realized. The need for a team approach to total medical, speech, and vocational rehabilitation is indicated.

Adult

Sexual counselling--a dual counselling approach.

A technique has been described which utilises a dual counselling approach to handle problems of a sexual nature. The methods used to structure counselling sessions are discussed as well as the benefits and the drawbacks of using a male and female counsellor to assist people who have some failure in their sexual lifestyle.

Counseling

How do we counsel patients on short- and long-term complications after hypospadias repair? - A survey study.

INTRODUCTION: Hypospadias correction remains one of the most performed pediatric urologic procedures, affecting up to 1/150 males born in the United States. Current studies suggest that surgical counseling has a significant impact on shared decision making, decisional regret, and long-term follow-up. However, no set paradigm currently exists for long-term follow-up or counseling. We sought to obtain consensus from established pediatric urologists the optimal content and potential short, intermediate, and long-term complications to be considered when counseling patients and parents of patients with hypospadias. METHODS: We conducted an IRB-approved survey study, which sampled the responses of Pediatric Urologists from National and International listservs. A google scholar search was performed using key words including "hypospadias" and "long-term complications." Descriptions of pertinent short, intermediate and long-term complications were identified and compiled from existing patient handouts. Survey items were then developed asking respondents to rate proposed descriptions, provide potential edits, and describe their overall approach to counseling. RESULTS: A total of 290 surgeons were contacted with 120 (41 %) responding. In total, 89 respondents (74 %) identified as male and 105 (88 %) had undergone a pediatric urology fellowship. Most surgeons described a reliance on verbal counseling (95 %) with the assistance of hand-drawn diagrams (75 %) to explain long-term care, rather than electronic or audiovisual materials (3-12 %). Of note, fewer surgeons endorsed routine discussion of long-term complications (Range 29.2 %-50.8 %) than shorter-term complications (56.7 %-89.2 %). On a Likert scale, physicians reported that they were mostly satisfied (72 %) with their current approaches to counseling. DISCUSSION: Perioperative counseling has an important yet often overlooked role in surgical care. The aim of this study was to better understand current counseling practices in pediatric hypospadias to identify gaps in urologic care and areas for improvement as one of the most common conditions treated by pediatric urologists. Our results suggest that surgeons who perform hypospadias repairs have potential to include more comprehensive discussion during post-operative follow-up. We proposed a preliminary counselling guide for these concerns which incorporates language from the most commonly selected complication description by survey respondents. Future studies will involve expert consensus and patient input to confirm the adequacy of the content, the method of delivery, content appearance, and accommodations for health literacy. Limitations of the study include small sample size and response bias. The results are reflective of the summed responses of participants and are not reflective of individual providers or practices. Importantly, this study omits the input of other advanced practice providers (nurse practitioners, physician assistants, etc.), nurses, and ancillary staff who are also crucial to hypospadias care. The proposed counseling guide represents a first attempt at creating standardization of hypospadias counseling. CONCLUSION: Surgeons who perform hypospadias repair do not routinely discuss long-term complications after repair, though are overall satisfied with their counseling practices. Better tools, such as improved multimodal counseling guides, could be used to deliver this counseling efficiently and accurately to ensure patients receive optimal long-term care. Future studies will focus on developing educational materials for short, intermediate, and long-term counseling on complications after hypospadias repair with input from patients and clinicians.

Humans

Psychological responses to genetic counseling for Down's syndrome.

To assess some of the emotional aspects of why parents seek genetic counseling and to measure the effect of genetic counseling in parents of children with Down's syndrome, pre- and post-counseling measures of anxiety, hostility, depression, and self-concept were obtained from 43 parents. Pre-counseling responses were compared with those of normative controls, and pre- and post-counseling scores were compared for areas of significant change. Anxiety, hostility and depression levels were significantly higher in parents seeking counseling than in normative controls (both P less than 0.002). Following genetic counseling, there was a significant lowering of anxiety (P less than 0.0005) and depression (P less than 0.05) along with a significant increase in overall self-concept (P less than 0.01). The study documents the importance of looking at factors related to emotional needs and self-image of parents in genetic counseling.

Adolescent

School counseling and positive mental health: when does 1 + 1 = 3?

School counseling and guidance services are specifically intended to develop and maintain positive mental health among students. Although some school counselors have been highly effective, the majority have been only moderately effective because of the difficulties they have encountered in this mission. Personal, academic, and vocational counseling and information processing from either remedial or preventative perspectives are currently the most common functions within school counseling services. The factors limiting the effectiveness of these and other school counseling functions include discrepancies between school counseling training and practice, school counselor professional isolationism, lack of understanding of school counseling roles and functions, and the poor professional attitudes of some school counselors. As the school counseling profession develops, these inhibiting factors should be overcome as a result of changes in school counselor roles and activities and associated changes in school counseling and guidance services.

Attitude

The effectiveness of genetic counselling for neural-tube malformations.

A total of 160 couples who, between 1967 and 1974, had had genetic counselling because of neural-tube malformations in a previous pregnancy were later interviewed in their homes to assess the effectiveness of the counselling. In the earlier years, few couples in which the husband was in a manual occupation came for counselling, but latterly the proportion increased. Most couples seen together for counselling acted appropriately on the risks given, but only when very high or low risks were given were these remembered accurately. Both accurate recall and appropriate action tended to be compromised by poor preparation of the couple for counselling, by too early a consultation after the birth of an abnormal child, by survival of the child, or by psychiatric illness. Before prenatal diagnostic tests became available, few couples embarked on further pregnancies, but more recently half the couples started a further pregnancy within one year and only one in five couples decided against having more children. It is concluded that couples at risk should be persuaded to seek counselling, and be better prepared for it beforehand, that counselling should not take place too soon after the birth, and that there should be later follow-up. Couples should be seen together, and a non-directive approach usually should be adapted. More public education would help to bring the service to more of the families most in need of it.

Genetic Counseling

(Re)imagining the Future of Genetic Counseling: A Reflexive Qualitative Analysis of Sociopolitical Power, Cultural Safety, Systemic Racism, and Comparative Practice in the United Kingdom, Aotearoa New Zealand and, Australia.

Genetic counseling is undergoing a rapid transformation as genomic medicine becomes embedded within mainstream healthcare systems. At the same time, the profession is being challenged to respond to systemic racism, colonial legacies, technological change, and evolving expectations regarding equity and justice. Historically, genetic counseling emerged within twentieth-century medical genetics and was influenced by political, social, scientific, and medical forces that included eugenic ideology, values, and practices. The profession has since evolved substantially toward psychosocial, patient-centered, and non-directive models of care. Contemporary debates regarding "newgenics" or "neugenics" further demonstrate how concerns regarding equity, reproductive ethics, disability, and genomic stratification continue to shape genomic healthcare discourse. This qualitative reflexive practice paper explores how systemic racism, colonial legacy, cultural safety and structural power shape genetic counseling practice in the United Kingdom (UK), Aotearoa New Zealand and Australia, and how these forces continue to reshape the profession's future identity. A reflexive, narrative, and comparative qualitative approach was employed, grounded in the authors' lived professional experiences across UK and Australasian contexts and informed by purposively selected policy, professional and scholarly literature relating to cultural safety, dignity, anti-racism, and Human Rights-Based Decision-Making. Through iterative reflexive dialogue, comparative analysis, and thematic synthesis, four interrelated themes were developed examining sociopolitical context, systemic racism, cultural safety and technologization within contemporary genetic counseling practice. Comparative analysis identified substantial differences in how culturally responsive practice is conceptualized and operationalized across settings. In Aotearoa, cultural safety is strongly shaped by Te Tiriti o Waitangi, bicultural accountability, and Māori sovereignty frameworks. In Australia, culturally safer genomic care has increasingly developed through Indigenous-led initiatives and workforce reform, including the Australian Alliance for Indigenous Genomics (ALIGN). In contrast, UK practice remains largely situated within equality, diversity, and inclusion (EDI) frameworks that may insufficiently address systemic racism and structural power within increasingly diverse populations. Reflexive clinical examples demonstrated how inequities may emerge through undocumented patient values, standardized pathways, assumptions regarding autonomy, and misinterpretation of culturally specific communication styles. Re-imagining the future of genetic counseling requires more than just technological advancement. It requires reflexive engagement with dignity, inequity, and the sociopolitical realities of the populations served. These insights re-imagine a culturally grounded, socially responsive future for genetic counseling in an era shaped by genomic mainstreaming, digital transformation, artificial intelligence and workforce reform and one in which the profession remains ethically anchored, relationally attuned, and committed to justice-oriented practice.

Humans

Optimizing smoking cessation pharmacotherapy and counseling for adult primary care patients: a factorial randomized controlled trial.

BACKGROUND: Even with the most effective smoking cessation pharmacotherapies (i.e., varenicline or combination nicotine replacement [C-NRT]), the majority of people ultimately return to smoking. This research explored how to optimize the use of varenicline and C-NRT to promote smoking cessation. METHODS: Primary care patients participated in a 2x2x2x2 factorial experiment that evaluated 4 factors: 1) Medication Type (Varenicline vs. C-NRT [patch + mini-lozenge]), 2) Preparation (pre-quit) Medication (4 Weeks vs. Standard); 3) Medication Duration (Extended [24 weeks] vs. Standard [12 weeks]); and 4) Counseling Type (Cessation Counseling [4 sessions] vs. Referral Support [2 sessions focused on use of referral resources]). This study was discontinued prior to reaching the proposed sample size (N = 608) due to pandemic-related budgetary constraints. RESULTS: Participants (N = 496) were 55% women and 45.6% Black individuals. There were no statistically significant main effects of the 4 factors on abstinence at 12, 26 or 52 weeks. There was a 3-way interaction between Medication Type, Preparation Medication, and Counseling Type (p = 0.04) predicting the primary outcome of biochemically confirmed abstinence at 52 weeks; cessation counseling vs. referral support improved varenicline quit rates when 4 weeks versus 1 week of pre-quit medication was offered. For C-NRT, counseling type did not significantly improve quit rates regardless of the use of preparation medication. CONCLUSIONS: There was no robust evidence that enhanced pre-quit or extended duration of varenicline or C-NRT increased abstinence rates. More intensive counseling may support cessation for different pharmacotherapy regimens. Given the lack of consistent findings, this research should be viewed as exploratory to guide future research.

Humans

AI'm Here to Help: Enhancing Laboratory Genetic Counseling with Artificial Intelligence.

BACKGROUND: Artificial intelligence (AI) is transforming the fields of genetics and genetic counseling, enhancing both clinical and laboratory practices. The rise of AI technologies has drawn attention to their potential impact on genetic counseling, particularly in patient diagnosis and the counseling processes. CONTENT: In the laboratory, AI plays a critical role in improving communication between laboratory genetic counselors and healthcare providers by automating routine tasks and optimizing workflows. These advancements allow genetic counselors to dedicate more time to addressing complex inquiries, improving genetic test selection, and helping providers interpret genetic test results. As AI continues to integrate into laboratory genetic counseling practice, it presents both opportunities and challenges. At the time of submission, there is a large knowledge gap regarding AI and its application to laboratory genetic counseling, given the lack of published information on this topic. SUMMARY: This article summarizes existing literature, the history and current applications of AI in laboratory genetic counseling, examines its benefits and limitations, and explores future directions for its implementation in the field.

Humans

Prospective study of genetic counselling.

A prospective study was carried out on 200 consecutive subjects seen for counselling (consultands) for serious genetic disorders. Educational and social background of consultands and their knowledge and understanding of their particular problem were assessed before counselling, and their response was determined immediately afterwards and three months and two years later by an independent observer not concerned in the genetic counselling. The husband's educational background was particularly important in influencing a couple's comprehension of counselling. X-linked recessive and chromosomal disorders presented the most difficulties in comprehension. The counsellors' assessment of comprehension was a good guide to the consultands' comprehension as assessed at subsequent follow-up. The proportion deterred from having children increased with time and over a third had been sterilised within two years of counselling. It is suggested that follow-up after counselling should be routine, especially when the counsellor suspects that comprehension has not been good, in X-linked recessive and chromosomal disorders, and when the risks of having an affected child are considered to be high.

Adult

Presurgical counseling needs of laryngectomaes: a survey of 78 patients.

Studies of candidated for laryngectomy have revealed a wide range of misconceptions about this surgery and its siquellae. To evalute current preoperative counseling practices, counseling deficits, and needs as perceived by the patient and his family, we surveyed all persons who had undergone laryngectomy at this institution since January 1974. The data indicated that present presurgical counseling practices are inadequate for most patients. There was considerable discrepancy between the actual counseling the patients received and what they considered ideal. For example, most received preoperative information only from their surgeons. Yet many indicated that laryngectomy candidates should be counseled by nurses, speech pathologists, recovered laryngectomees, and others. Almost all reported that the spouse should be present during counseling. Many survey respondents indicated that printed materials and/or audiovisual programs would also be desirable.

Adult

A detailed description of mothers' knowledge before genetic counseling for Down syndrome: Part I.

This study focuses on counselees' knowledge of the Down syndrome before receiving genetic counseling. Data were collected from 47 mothers of children with the Down syndrome using a structured interview of 13 open-ended questions. This instrument was found to be both internally reliable and consistent. Results of this study document the enormous variation of counselees' knowledge of the Down syndrome before genetic counseling and show that this is positively associated with their educational background. Counselees with more than a high school education knew about 60% of the genetic information pertaining to the diagnosis before genetic counseling, while those with less than a high school education knew only 23% of this information before counseling. These results indicate that the better educated counselees are less apt to need to learn basic genetic information and may seek out genetic counseling services for other reasons. Possible motives are seeking knowledge confirmation, emotional support, and personalization of the information.

Adolescent