test interpretation in counselingruth putnam the crucible

Professor of Educational Psychology. To subscribe to email alerts, please log in first, or sign up for a DeepDyve account if you dont already have one. The site is secure. HHS Vulnerability Disclosure, Help These challenges can occur for both genetics and non-genetics trained professionals who are providing the results to patients and their families. PDF ASSESSMENT in COUNSELING While there have been case studies providing examples of genetic test misinterpretation and its consequences, little is known regarding the frequency of challenges in interpreting genetic results, the contributing factors to these challenges, and the impact that such errors can have on clinical care. Errors in delivery of cancer genetics services: implications for practice, Whas the harm? Three anecdotal examples of each misinterpretation type (benign as pathogenic, variant of uncertain significance as benign or pathogenic, and pathogenic as benign) are included in Table 1. Goehringer JM, Bonhag MA, Jones LK, et al. The consequences of this type of misinterpretation are listed in Figure 2 (B). Carroll JC, Allanson J, Morrison S, et al. Federal government websites often end in .gov or .mil. Abstract and Figures. Finally, all cases highlight instances where interpretation of a genetic result is not straightforward, emphasizing the complexities to the interpretation process that we were unable to capture in the survey data. Communicating Assessment Results in the Counseling Interview. All DeepDyve websites use cookies to improve your online experience. This ultimately can lead clients to make more effective decisions. Many of the respondents (survey and case report) listed lack of genetic counseling as a possible cause for challenges in interpretation. Respondents were allowed to select more than one answer to account for the involvement of different types of healthcare professionals for respondents who had experienced multiple examples of result misconception. 1Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA, 2Department of Genetics, University of Alabama at Birmingham, Birmingham, Alabama, USA, 3Pediatrics, Division of Genetics and Genomic Medicine, Washington University at St Louis School of Medicine, St. Louis, MO, USA, 4Medical Genomics and Metabolic Genetics Branch, National Human Genome Research Institute, NIH, Bethesda, Maryland, USA, 5Center for the Study of Community Health, University of Alabama at Birmingham, Birmingham, Alabama, USA, 6Division of Genetics, Department of Pediatrics, University of California, San Francisco, California, USA. Reset filters. Require these words, in this exact order. Exclusivethesis.com 2009-2023 All rights reserved, Ethics in Testing, Assessment and Interpretation, The Idea of Ethical Subjectivism and Its Application to Moral Matters. HOWARD E.A. Chatbots & artificial intelligence to scale genetic information delivery, The counselor will videoconference you now: addressing opportunities and challenges with patient-clinician communication in the telemedicine era. Test interpretation in counseling. Understanding of inheritance patterns, genetic terminology, and report reading are all relevant when accurately interpreting genetic test results. All cases described by the respondents occurred in the setting of participants enrolled in IRB-approved clinical research protocols at the corresponding CSER sites. the vocational, clinical, educational, or other practical implications rendered to a specific test score. Research on the Effects of Test Interpretation: A Review Greenberg SE, Boothe E, Delaney CL, Noss R, Cohen SA. Test Interpretation Test Interpretation TINSLEY, HOWARD E.A. Patient assessment of chatbots for the scalable delivery of genetic counseling, Utilization of health information technology among cancer genetic counselors. showed a significant variation between cancer genetic test reports, which differed in content, length, recommendations, layout, and test description, among other parameters.55 They also reported significant difference in the reports' average reading grade level, which varied between 7th and 12th grade. Read and print from thousands of top scholarly journals. The authors declare no potential conflicts of interest. McClaren BJ, King EA, Crellin E, Gaff C, Metcalfe SA. Times ranged from days to years, but most often was reported to be weeks to months (45%). Skill in administration of tests and interpretation of test scores. Case submissions revealed that interpretation pitfalls extend beyond variant classification analyses. Each of these pitfalls is deserving of its own quantitative research so that the genetics community can better understand how to avoid the pitfalls and challenges inherent in genetic testing report interpretation. A study by Makhoon et al. Search for more papers by this author The authors would like to thank the following members of the CSER Consortium who provided feedback on this manuscript: Kelly East, MS, CGC (HudsonAlpha Institute for Biotechnology); Laura G Hendon, MA, MS, CGC (University of Mississippi Medical Center); Katie Gallagher, MS, CGC (Montefiore Medical Center). As seen in Table 2, there were often multiple perceived contributing factors to and consequence of the reported misinterpretation, and cases were not easily described by one factor. Study: genetic tests often overused and misinterpreted, https://uk.reuters.com/article/us-health-overtreatment-idUSTRE81F15Y20120216, https://www.eurekalert.org/pub_releases/2018-02/uos-iom022118.php, https://medicalxpress.com/news/2017-05-genetic-overused-misinterpreted.html, A newborn with a congenital anomaly had a targeted genetic test panel done prenatally and found a benign parentally-inherited variant was identified. A counselor has no right to deviate from the standards in using techniques, make the modifications in the already published procedure and distribute the modified guidance. The styles were used in . This is especially relevant given the low response rate. Test Interpretation - TINSLEY - 1986 - Journal of Counseling & Development - Wiley Online Library Test Interpretation HOWARD E.A. In his/her activities, a counselor should always keep in mind the principle of no harm. In doubtful and controversial cases, a psychologist is obliged to consult with an expert in the relevant field and objectively consider the recommendations received. This worksheet and quiz can help you practice the following skills: To learn more about assessments and tests in counseling, review the lesson on Testing and Assessment in Counseling: Types & Uses. The therapist then interprets the person's answers. The most common is a VUS interpreted as pathogenic or benign, followed by misinterpretation of a benign variant interpreted as pathogenic. Effects of test interpretation style and favorability in the counseling Twenty-four cases of misinterpretation by a medical professional not listed above were also reported. As the survey was not designed to determine the frequency of misinterpretation, our results are not amenable to quantitative analyses. Otten E, Birnie E, Ranchor AV, van Langen IM. The communication of probabilistic information through test PDF 1995 EDO-CG-95-26 ERIC Digest - American Counseling Association The goal of the survey was to identify instances of genetic result misinterpretation and to assess the clinicians' experience in how those cases affected patient care. C. Methods of administration. From helices to health: undergraduate medical education in genetics and genomics, Pitfalls in the interpretation of molecular diagnostic tests, Performance of ACMG-AMP variant-interpretation guidelines among nine Laboratories in the Clinical Sequencing Exploratory Research Consortium. Responses were compiled in graphical and tabular forms and the results were generated using Qualtrics and Microsoft Excel. Counseling Psychology Assessments - IResearchNet Due to the sensitive nature of the topic and to ensure complete anonymity, no participant demographics were obtained. The breakdown of types of health professionals involved in misinterpretation events is shown in Figure 1. Are Australasian genetic counselors interested in private practice at the primary care level of health service? For terms and use, please refer to our Terms and Conditions A future qualitative analysis of the 160 anecdotes submitted by survey respondents may provide another avenue to understand some of the pitfalls in genetic testing interpretation. Test interpretation may be enhanced by providingthe counselor with an expanded and consistent knowl-edge base to assist in the interpretation of test data. The authors notes that the principles stated in their article are based upon recognition of individual . Uncertainty in variant interpretation can lead to misdiagnosis, and prognostication is often problematic due to incomplete or age-dependent penetrance and variable expressivity.13,14 In addition, communication of genetic testing results to patients and providers can be complicated not only by the complexity of the results, but also by the technical language used in writing reports.15 Misinterpretation of genetic results can ultimately have significant consequences, including incorrect diagnoses, unnecessary treatments and interventions, increased psychosocial stress on patients and their families, and sometimes missed diagnoses, which may even lead to death.1624 Compounding this, there may be legal ramifications to providers and/or hospital systems that could present as malpractice. The effects of test interpretation styles and the status of tests in (B) Perceived consequences of the genetic report misinterpretation for all three potential variant misinterpretations types. Before Clients' recall and understanding of test interpretations are frequently incomplete. This requirement enables professional counselors to provide consultation and training to others who assist with test administration and scoring. It has been shown that clients who receive test interpretations generally make greater gains in incorporating the results. Brierley KL, Blouch E, Cogswell W, et al. FOIA Find any of these words, separated by spaces, Exclude each of these words, separated by spaces, Search for these terms only in the title of an article, Most effective as: LastName, First Name or Lastname, FN, Search for articles published in journals where these words are in the journal name, Personreferenced test interpretation: A learning process, Tests and counseling: The marriage that failed, The effects of different methods of test introduction and interpretation on client learning in counseling. The job of a genetic counselor: Interpret, inform and support View access options below. Improving molecular genetic test utilization through order restriction, test review, and guidance, Errors in genetic testing: common causes and strategies for prevention. To get new article updates from a journal on your personalized homepage, please log in first, or sign up for a DeepDyve account if you dont already have one. National Library of Medicine For example, therapists gain experience one client at a time, but tests provide information based on large numbers of people in the form of norm groups. Other examples of misunderstanding of genetic concepts include incorrect interpretation of de novo versus inherited variants (#1), the role of cis versus trans variants in autosomal recessive inheritance (#4), and the definition of incidental (secondary) versus primary findings (#2). The effects of test interpretation styles and the status of tests in Even if the test is carried out carefully and correctly interpreted, its results should be discussed in more detail in order to avoid any harm to the counselee. In case #3, a loss of function variant in PCSK9 was listed on a laboratory report as related to familial hypercholesterolemia (FH), but it did not clearly state that only gain of function variants in this gene causes disease. c. Is sensitive to cultural and social diversity among families and recognizes that all parents, custodial and noncustodial, are vested with certain rights and responsibilities for the welfare of their children by virtue of their role and according to law (The American School Counselor Association, 1998). TINSLEY, RICHARD W. BRADLEY First published: March 1986 https://doi.org/10.1002/j.1556-6676.1986.tb01166.x Citations: 13 PDF Tools Share Get access to the full version of this article. In particular, testing should be only . To assist students with formulating goals commensurate with their interests and abilities, a study incorporating planned testing and group counseling was conducted at a community college in the West. The survey was distributed to the three groups, totaling approximately 5000 members. Figure 2(B) shows a breakdown of the perceived effects of misinterpretation. Note: Select examples of the 160 anecdotes submitted by survey respondents, each representing a different type of perceived variant misinterpretation. Practicing in a competent and ethical manner. SAGE is a leading international provider of innovative, high-quality content publishing more than 900 journals and over 800 new books each year, spanning a wide range of subject areas. Allen CG, Gabriel J, Flynn M, Cunningham TN, Wang C. The impact of raw DNA availability and corresponding online interpretation services: a mixed-methods study, Attention: direct-to-consumer patrons: proceed with caution, Impact of misunderstanding genetic tests for heart conditions, The San Diego Union-Tribune. The limitations of tests with regard to both reliability and predictive validity are addressed, especially in individual diagnosis and prediction. A total of 40/242 (16%) of surveyed individuals had encountered at least one case of a pathogenic result being interpreted as benign. Principal offices are located in Los Angeles, London, New Delhi, Singapore, Washington DC and Melbourne. This study was approved by the Institutional Review Board (IRB) of the University of Alabama at Birmingham. Here we describe the descriptive statistics that were collected through the survey. Southern Illinois University at Carbondale. WGS reported 47,XXY as an incidental finding and did not identify any variants associated with the indication for testing. Different Type of Test for The Purpose of Counselling - SlideShare Test Interpretation - an overview | ScienceDirect Topics One explanation for the argument that tests contribute little to the counseling process, may be that counselor training has focused on technical aspects of testing rather than application. Communicating Assessment Results in the Counseling Interview. Secondly, incorrect counseling of patients despite correct classification of the variant can also occur. To save an article, log in first, or sign up for a DeepDyve account if you dont already have one. As a library, NLM provides access to scientific literature. Further research is needed to validate and quantify large-scale data regarding challenges of genetic results interpretation. Which . Individuals should not be told the results of testing without their interpretation. Genetic testing is increasingly employed in the evaluation of medical conditions, ranging from neurocognitive disorders with childhood onset to the development of cancer in adults.1 The involvement of all age groups and expansive clinical indications for genetic testing have led to an increased demand for genetic tests and ordering of these tests by health professionals without formal training in genetics.2 Coupled with this increase demand for testing is the rapid advancement of genomic technology, resulting in an increased complexity of genetic testing options to clinicians who may need to order and interpret genetic tests as a part of patient care.3 These advances in the genomic era have been swift, and medical schools may not be able to cover the nuances of genomic test interpretation in a traditional course schedule.48 Nevertheless, there is a recognized shortage of trained medical geneticists and genetic counselors, so health professionals without formal training in genetics have increasingly been involved in ordering and interpreting genetic testing especially as the enthusiasm for genomic medicine continues to rise.912, Despite the spread of genomic medicine throughout the US healthcare system, its benefits cannot be fully realizedand perhaps, may be negatedif genetic testing results are misinterpreted. Other causes included ordering of an incorrect test and unclear wording of the genetic testing report. The publisher's final edited version of this article is available at, GUID:B2CCCCD9-4652-48A0-B381-424856D9C019, GUID:54CF1D78-2B73-4890-8D5F-191234264F3D, GUID:4382C29D-D433-4800-8C6E-C62FF7324550, genetic counseling, genetic results, medical error, medical genetics, misinterpretation. We then asked for information on the role of the healthcare professional involved in the misinterpretation of genetic results. Many respondents shared anecdotes detailing the consequences of the misunderstanding that included unnecessary testing, organ removal, pregnancy termination and decisions to withdraw care, all based on benign results that were reportedly misinterpreted as pathogenic (see Table 1). It is reliable but not valid. We'll do our best to fix them. (2) Client welfare: counselors, social workers, and marriage and family therapists shall promote the welfare and best interests of the client in the . Despite this, family was told child had diagnosis of autosomal recessive condition. The .gov means its official. Finally, this study cannot be used to infer how often misinterpretation occurs, as respondents indicated instances of misinterpretation without specifying the total number of genetic tests with which they have been involved or the number of years that they have spent in practice. This quiz and worksheet combo helps you gauge your understanding of different assessments used in counseling. However, this type of work has its own characteristics, which lies in the fact that a psychologist having an ability to influence the psychological state of a client, as well as his/her later life, performs primarily ethical responsibility towards his/her counselee. Future research regarding frequency of instances of misinterpretation among clinicians using a more structured approach with piloting and validation of survey questions is an important next step to this work. Respondents also listed unclear wording of a genetic test result as a potential challenge for result interpretation. This is an instance where lack of communication between the laboratory and provider may not have directly caused the misinterpretation, but could have contributed to it. Karyotype, single gene sequencing, and del/dup studies were ordered for a patient from the same laboratory. Bennett CL, Burke SE, Burton H, Farndon PA. A toolkit for incorporating genetics into mainstream medical services: learning from service development pilots in England. Test interpretation. - APA PsycNet To begin, the ethical concept, as indicated by ACA (2014), is based on the following main principles of psychological counseling, which a counselor is forbidden to violate: In this regard, the professional ethical behavior of a consultant undertakes to meet the following principles: In general, the ethical requirements presented by ASCA and ACA have much in common and argue that the ethical behavior of a counselor is directly related to the level of his/her competence, which finds its expression in the course of testing. Select data courtesy of the U.S. National Library of Medicine. 2023 DeepDyve, Inc. All rights reserved. Effects of Test Interpretation Style and Favorability in the Counseling Chromosome analysis revealed Tetrasomy X, but result of the single gene testing was labeled as positive. The remainder of the report included language about the condition associated with this gene, despite the fact that the results did not point towards this patient having the condition. SAGE remains majority owned by our founder and after her lifetime will become owned by a charitable trust that secures the companys continued independence. Participants were aware that their responses were being used as part of a study by investigators at the University of Alabama at Birmingham. Current conditions in medical genetics practice, Expanding the genetic counseling workforce: program directors' views on increasing the size of genetic counseling graduate programs, Adapting genetic counseling training to the genomic era: more an evolution than a revolution. There is curently is no standard in genetic test report wording and formatting. Adjunct Clinical Supervisor, Applied Psychology, Associate Professor of Applied Psychology, Interpretation and Use of Tests in Counseling Adults. Test Interpretation - IResearchNet The translation of genetic testing results from provider to patient through unclear genetic counseling was also a perceived contributing factor to misinterpretation in the case reports (cases #1 and #6). Parents told by neonatologist in the delivery room that infant had features of a specific genetic syndrome. Information recall . b. organize and interpret data c. recommend interventions d. all of the above. Bonadies DC, Brierley KL, Barnett RE, et al. Two styles of test interpretation, delivered and interactive, were compared in ongoing career counseling for 26 university honors students. B. A. Characteristics of its standardized sample. A counselor must do everything possible not to cause any mental or psychological harm to the minor with whom he/she works. Test results in counseling constitute interventions that can facilitate change and lead to greater awareness, knowledge, and self understanding. Interpreting test scores to clients: What scores should one use? Aptitude, achievement, interest, behavioral, and personality instruments are presented. Other publications have discussed ways to reduce the likelihood of misinterpretation, and improved education of medical professionals has emerged as a common theme.3235 While the need for increased education of non-genetics professionals in clinical genetics has long been appreciated, it is clear that pitfalls in interpretation can still occur with formal genetics training. Laboratory recommended deletion/duplication studies to confirm homozygous deletion. De novo variant of uncertain significance in found in a premature infant: provider reported that the variant wasnt paternally or maternally inherited without discussing the mechanism of de novo variants. Art and challenges of precision medicine: interpreting and integrating genomic data into clinical practice. Reanalysis concluded variant was likely diagnostic in this case. The most frequent reported consequence was perceived patient stress. Studies have evaluated what providers value in test result reporting for genome sequencing, but studies to determine what is valued in reports for other types of genetic testing, such as microarray, are lacking.56 One of the main conclusions of the CLARITY Challenge through Boston Childrens Hospital is the need for greater attention to the development of clear, concise clinical reports, with common elements such as use of reference accession numbers and genome builds, consistent criteria for definition of pathogenicity (or degree of uncertainty).57 Further research is warranted to evaluate if changing laboratory reporting structure and language may help mitigate interpretation errors. As such, the 360 responses sufficed for a rich response. These cases, although anecdotal, allowed for an in-depth exploration of the experiences with misinterpretation of genetic testing results from a group of genetics professionals.

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