Advanced Counselling and Ethical Practice for Genetic Counsellors —
Training activity: 1

Details

Communicate and negotiate effectively with an individual about what is to be achieved in genetic counselling consultations, taking into account the concerns and priorities of the individual/couple/family, as well as what can realistically be delivered

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

• Active listening skills to elicit information
• Establishment of good rapport with the individual/family
• Managing patient expectations
• Clinical guidelines and testing protocols
• Factors that may influence communication such as age, capacity, language and learning ability
• Manage expectations and timeframes
• AGNC code of ethics
• GCRB code of conduct
• Good scientific practice
• HCPC standards of proficiency

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?

• Identify what you are able to offer the patient and how you will communicate this, while also establishing the personal/family agenda.
• Consider how the learning outcomes apply, specifically in relation to ensuring that the patient’s concerns and priorities are understood and addressed within the realistic scope of the consultation.
• Discuss with your training officer to gain clarity of what is expected of you in relation to a well-negotiated and agreed-upon consultation agenda.

What is your prior experience of this activity?

• Think about what you already know about negotiating expectations or clarifying the purpose of a clinical encounter.
• Consider possible challenges you might face during the activity, such as discussing what can and cannot be achieved in a limited timeframe.
• 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. You will need to seek advice from your Training Officer when required, for example if patient expectations significantly conflict with what the service can realistically deliver, requiring mediation or alternative solutions.
• Acknowledge how you feel about leading the negotiation of a consultation agenda.

What do you anticipate you will learn from the experience?

• Consider the specific skills you want to develop, such as specific communication or negotiation strategies, drawing upon previous experiences of the activity.
• Identify the specific insights you hope to gain into effectively aligning patient expectations with the services provided.

What additional considerations do you need to make?

• Consider your previous experiences of negotiation or clinical expectation setting, including any feedback you may need to apply here.
• Establish what clinical information you will need, such as the availability of screening or testing.
• Identify what information you need to consider about the patient/family and how this might help you to anticipate their concerns or priorities.
• Consider whether there are any specific factors that might affect this encounter, such as the appointment format, multiple family members, or patient access needs.

In action

Is anything unexpected occurring?

• Are you noticing anything surprising or different from what you anticipate whilst actively working to communicate and negotiate the consultation goals with the patient?
• Are you encountering situations such as:
  • The individual states a highly unrealistic goal (e.g., expecting test or treatment options outside the scope of current NHS care) that challenges the purpose of the consultation?
  • The negotiation breaks down due to deeply conflicting priorities between a couple or family members?

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 exploring the underlying reasons for the unrealistic goals or conflict?
• Consider the steps you are taking in the moment, such as: Immediately adjusting your communication style to explore the basis of the conflict or unrealistic expectation; or pausing the negotiation to reflect the patient’s emotional intensity.
• How are you feeling in that moment? For instance, are you finding it difficult to guide the conversation back to achievable consultation aims? Is it affecting your confidence in establishing shared, realistic goals?

What is the conclusion or outcome?

• Identify how you are working within your scope of practice. For example, were you able to successfully negotiate shared goals within the realistic scope of genetic counselling? Or are you needing support because the patient’s goals necessitate immediate consultation with the multidisciplinary team regarding complex, non-genetic solutions?
• What are you learning as a result of the unexpected development? For example, are you mastering a more effective technique for managing highly unrealistic patient expectations at the outset of a consultation?

On action

What happened?

• Begin by summarising the key steps you took when approaching the initial phase of the consultation to communicate and negotiate the agenda.
• Consider specific events, actions, or interactions which felt important, such as the moment a patient priority (e.g., anxiety about insurance) was disclosed, shifting the focus of the consultation.
• Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, shifting your focus to explore underlying conflict or unrealistic expectations expressed by the patient or family.
• How did you feel during this experience, e.g., did you feel focused on active listening but challenged by the patient’s reluctance to state their true priorities?

How has this experience contributed to your developing practice?

• Identify what learning you can take from this experience regarding effective agenda setting. What strengths did you demonstrate, e.g., effective rapport building which facilitated the eventual disclosure of the main concern?
• What skills and/or knowledge gaps were evident, e.g., difficulty discussing and agreeing upon what could realistically be achieved in the consultation?
• Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved? Has your practice improved in identifying priorities and managing expectations?
• Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding how to manage a fundamental disagreement over realistic goals, and how you reacted to this.
• Identify any interventions or techniques that worked well. What about them helped the consultation?

What will you take from the experience moving forward?

• Identify the actions or ‘next steps’ you will now take to support the assimilation of what you have learnt, including from any feedback you have received, with regards to improving ability to communicate and negotiate consultation goals.
• What will you do differently next time you approach agenda setting, for instance, proactively summarising the patient’s concerns back to them to ensure clarity?
• Do you need to practise any aspect of the activity further, such as negotiation techniques or aspects of managing expectations?

Beyond action

Have you revisited the experiences?

• How have your subsequent experiences of negotiating consultation goals since completing this specific training activity led you to revisit your initial approach? For example, a subsequent case involving conflicting family agendas might prompt you to re-evaluate your initial approach to exploring competing psychosocial priorities. Perhaps you now tackle this more proactively or openly.
• Considering what you understand about listening skills, psychosocial factors, and tailoring consultations now; how have you since developed your agenda-setting practice? For example, you might have integrated a specific check-back question to confirm the patient’s primary concern, based on feedback from an observing genetic counsellor.
• Has discussing challenges in agenda setting (such as ambiguous initial patient agendas, or the impact of missing the patient’s underlying concern) with colleagues, peers, or supervisors changed how you now view your initial experience in this training activity?

How have these experiences impacted upon current practice?

• How has the learning from this initial training activity, in combination with subsequent agenda identification and rapport-building experiences, contributed to your overall confidence and ability in establishing a patient-centred focus?
• How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to identifying the patient’s priorities?
• Looking holistically at your training journey, how has this initial agenda identification experience, revisited with your current perspective, contributed to your development in meeting the learning outcomes related to applying counselling skills and practicing safely and effectively?

Relevant learning outcomes

#	Outcome
# 1	Outcome Lead on establishing the patient agenda and psychosocial needs in complex genetic and genomic counselling consultations, under the supervision of a GCRB registered Genetic Counsellor.