Training activity information
Details
Facilitate patients’ decision-making when considering whether to have a predictive/pre-symptomatic genetic test in a trainee-led consultation
Type
Entrustable training activity (ETA)
Evidence requirements
Evidence the activity has been undertaken by the trainee repeatedly, consistently, and effectively over time, in a range of situations. This may include occasions where the trainee has not successfully achieved the outcome of the activity themselves. For example, because it was not appropriate to undertake the task in the circumstances or the trainees recognised their own limitations and sought help or advice to ensure the activity reached an appropriate conclusion.
Reflection at multiple timepoints on the trainee learning journey for this activity.
Considerations
- Counselling skills to:
- Empower individuals to consider their options
- Assess the individual’s understanding of the decision
- Elicit the individual’s motivation and preferences for predictive/pre- symptomatic genetic testing
- Other sources of support for the individuals, including:
- Other agencies (e.g. for psychological support and mental health services)
- Patient support groups
Reflective practice guidance
The guidance below is provided to support reflection at different time points, providing you with questions to aid you to reflect for this training activity. They are provided for guidance and should not be considered as a mandatory checklist. Trainees should not be expected to provide answers to each of the guidance questions listed.
Before action
What does success look like?
- Review the relevant learning outcomes focusing on applying counselling skills and facilitating decision-making.
- Discuss with your training officer to gain clarity of what is expected of you, specifically related to presenting balanced information about the benefits and limitations of testing and exploring complex motivations for proceeding.
What is your prior experience of this activity?
- Think about what you already know about predictive or pre-symptomatic genetic testing or about supporting patients in making decisions.
- Consider possible challenges you might face during the activity, such as managing patient anxiety, discussing the implications of a positive or negative result, or dealing with potential family conflict and think about how you might handle them.
- Recognise the scope of your own practice for this activity, i.e., know when you will need to seek advice or help and from whom, such as making referrals to psychological support or patient organisations.
What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop, such as exploring reasons for testing, presenting balanced information about benefits and limitations, or clarifying patient values and ethical concerns, drawing upon previous experiences.
- Identify the specific insights you hope to gain from engaging with the activity, such as the psychological process individuals go through when considering predictive testing or how they weigh potential risks and benefits.
What additional considerations do you need to make?
- Identify important information you need to consider before embarking on the activity, such as the natural history of the condition, the penetrance and variability of the gene mutation, availability of screening or intervention, and relevant ethical guidelines.
In action
Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst actively facilitating decision-making about predictive/pre-symptomatic testing?
- Are you encountering situations such as:
- The patient reveals unexpected fears, anxieties, or motivations for testing (e.g., family pressure, insurance concerns)?
- They express ambivalence or indecision that you hadn’t anticipated?
- They seem to misunderstand key concepts about predictive testing despite your explanations?
How are you reacting to the unexpected development?
- How is this impacting your actions? For example, are you responding to the situation appropriately? Are you adapting or changing your approach to your explanation of the test or the implications of the results to address misunderstanding?
- Consider the steps you are taking in the moment, such as immediately using specific counselling skills (e.g., reflection, clarification) to explore their underlying feelings or motivations.
- How are you feeling in that moment? For instance, are you finding it difficult to support them towards clarifying their testing decision? Is it affecting your confidence in managing the potential psychological implications of the discussion?
What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, were you able to support the patient in exploring their reasons for and against predictive testing and clarify their thinking about the decision? What are you learning as a result of the unexpected development? For example, are you learning in the moment about the unique psychological challenges in facilitating decision-making for predictive genetic testing?
On action
What happened?
- Begin by summarising the key steps you took when exploring the patient’s motivations and concerns related to predictive/pre-symptomatic testing.
- Consider specific events, actions, or interactions which felt important, such as the interaction where the patient revealed severe anxiety about the implications of a positive result for their children, complicating their decision.
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately pausing the technical discussion about test implications to address the patient’s emerging needs using core counselling skills.
- How did you feel during this experience, e.g., did you feel focused on supporting their autonomy but challenged by the depth of their psychological response?
How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience regarding facilitating decision-making for predictive testing. What strengths did you demonstrate, e.g., clear communication of risk information? What skills and/or knowledge gaps were evident, e.g., unfamiliarity with managing acute anxiety related to future genetic risk?
- Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved? Has your practice improved in facilitating clarity of decision-making?
What will you take from the experience moving forward?
- Identify the actions you will now take to support the assimilation of what you have learnt, including from any feedback you have received, with regards to improving my ability to assess and manage the responses to genetic risk (e.g., monitoring or blunting).
- What will you do differently next time you approach facilitating decisions about predictive testing, for instance, by proactively discussing specific coping strategies with the patient during the pre-test counselling phase?
- Do you need to practise any aspect of the activity further, such as using advanced counselling skills (e.g., concreteness and challenge) to explore ambivalence or key learning outcomes related to facilitating decision-making?
Beyond action
Have you revisited the experiences?
- How have your subsequent experiences of counselling patients for future risk since completing this specific training activity led you to revisit your initial approach or decisions during that activity?
- Considering what you understand about uncertainty management, ethical disclosure, and patient autonomy now, were the actions or considerations you identified after your initial reflection on this training activity sufficient? How have you since implemented or adapted improvements in your facilitation technique for predictive testing based on further learning and experiences? For example, how you proactively integrated core counselling skills (e.g., advanced empathy, concreteness) to better explore patient attitudes about testing.
How have these experiences impacted upon current practice?
- How has the learning from this initial training activity, in combination with subsequent risk counselling experiences, contributed to your overall confidence and ability in supporting patients through complex personal choices?
- How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to facilitating decisions about predictive testing? How does this evolved understanding help you identify when something is beyond your scope of practice or requires escalation?
- Looking holistically at your training journey, how has this initial predictive testing decision-making experience, revisited with your current perspective, contributed to your development in meeting the learning outcomes related to facilitating decision-making? For example, how this foundational experience has supported your development in practicing safely by providing the necessary knowledge base for the subsequent learning outcomes focused on identifying support agency referrals.
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 1 |
Outcome
Apply counselling skills within genetic and genomic counselling consultations. |
| # 3 |
Outcome
Employ counselling skills to facilitate individual/couple and family decision-making. |
| # 4 |
Outcome
Identify opportunities to make referrals for individuals and/or families to other support agencies. |