The Integration of Noninvasive Prenatal Screening into the Existing Prenatal Paradigm: a Survey of Current Genetic Counseling Practice

Since its introduction four years ago, noninvasive prenatal screening for fetal aneuploidy (NIPS) has been widely adopted as a screening tool for women at a high risk for fetal aneuploidy. As use expands into the general population, questions arise concerning the integration of NIPS into preexisting screening paradigms. This study aims to examine the use of NIPS in current practice among prenatal counselors, predominantly in the United States, in order to inform strategies for the optimal use of both new and existing screening techniques. We electronically surveyed 208 members of the National Society of Genetic Counselors to ascertain how NIPS is currently being used. Genetic counselors were also queried as to the advantages and disadvantages of offering NIPS to all patients regardless of a priori risk. Results indicate substantial variation in practice regarding which patients are offered NIPS and how counselors have incorporated this technology into existing screening routines. The majority of participants report offering NIPS in conjunction with another method of screening for fetal aneuploidy, indicating that NIPS is being used as an addition rather than as a replacement. These screening methods primarily include nuchal translucency (NT) (45.1 %, n = 78) and first trimester serum screening, with or without an NT (19.7 %, n = 34). Furthermore, the majority report that they would be concerned about losing the clinical value of an NT in a complete transition to NIPS (85.4 %, n = 164). Counselors are evenly split on the merits of expanding the use of NIPS to the general population (con: 55.3 %, n = 105; pro: 44.7 %, n = 85). The lack of consensus suggests that updated practice guidelines might benefit counselors. In addition, respondents emphasized the need to better educate patients and providers about the risks, benefits, and limitations of the test.     

Marketing of Professional Counselors: A Q‐Sort Study of Best Practices

This quantitative Q‐sort research was designed to evaluate representations of counselor qualifications and to determine which configurations account for the variance in consumer preference and selection. The sample consisted of 161 graduate and undergraduate students in a regional university in Texas. An iterative inverse factor analysis produced 3 distinct factors that accounted for 65.85% of the variance in the data, explaining a majority of the differences in how consumers perceive counselor credentials.     

Patient Perspectives on Intimate Partner Violence Discussion during Genetic Counseling Sessions

Intimate partner violence (IPV) is a major health concern in the United States (ACOG 2013). The World Health Organization (WHO) describes IPV as any physical, sexual, psychological harm by a current or former intimate partner (WHO 2016). Due to the psychosocial depth and nature of discussions within genetic counseling sessions, patients may disclose and/or discuss IPV as it relates to sexual well-being, reproductive and overall health. This study aims to assess the role for IPV screening, counseling and intervention in genetic counseling practice by investigating the incidence, experiences and attitudes about IPV among genetic counseling patients. Patients receiving genetic counseling at an urban metropolitan hospital were anonymously surveyed about experiences and perspectives on IPV as a topic of discussion during genetic counseling sessions. Among 60 eligible patients, 50 completed the survey (49 females, 1 male, of which, 5 identified as LGBT) ages 20 to 66. The incidence of IPV in this group was 16.0 % (n = 8). Majority of participants had never been asked about IPV by a healthcare provider (n = 32; 64.0%), would have felt comfortable answering questions about IPV by their healthcare provider (n = 34; 68.0%), and would have felt comfortable answering questions about IPV by their genetic counselor (n = 39; 78.0%). Perspectives from all participants, notably those with IPV history, provided insights to the role of genetic counselors in areas for IPV screening and counseling training.     

Patterns in Blame Attributions in Maltreated Youth: Association with Psychopathology and Interpersonal Functioning

This investigation explored patterns of blame attributions in 128 youth, primarily (87%) female, with maltreatment histories. Second, the study also evaluated the relative variance in posttraumatic stress disorder (PTSD) symptom severity, emotional distress, and interpersonal functioning outcomes, accounted for by age, abuse characteristics, and blame attribution patterns. Cluster analyses revealed distinctive blame profiles: high perpetrator blame, moderate perpetrator blame, high self-blame, high perpetrator/high self-blame, and low perpetrator/low self-blame. Regression analyses yielded significant models, accounting for 15% to 34% of the variance of outcomes. Most notably, youth endorsing a high perpetrator/high self-blame (i.e., compounded blame) attribution pattern reported poorer outcomes as compared to youth presenting with other blame profiles. Maltreatment type and age differences were not demonstrated across clusters. Implications and limitations are discussed.     

Emotional and Cognitive Processing in Sexual Assault Survivors' Narratives

Sexual assault sequelae include posttraumatic stress disorder (PTSD), depression, and substance use. Seminal treatment models have been developed based on emotional (Foa & Kozak, 1986) and cognitive (Resick & Schnicke, 1992) theories, and determined to be efficacious. Studies also have documented the utility of Pennebaker and Beall's (1986) narrative writing paradigm for trauma- related depressive and PTSD symptoms. Recently investigations have sought to explicate its benefit, focusing on mechanisms of action. This study aimed to examine the emotional activation and cognitive processing across narrative writing sessions with undergraduate sexual assault survivors. Results revealed statistically significant reductions in depressive symptoms and alcohol use, but not PTSD symptoms. Clinically meaningful and statistically significant emotional activation and habituation occurred within and across sessions. Implications and limitations are discussed.     

Genetic Counselors’ Perception of the Effect on Practice of Laws Restricting Abortion

In 2013, twenty-two states enacted seventy provisions restricting access to abortion. The legislation restricted access to abortions by instituting more regulations on providers and facilities, by prohibiting abortion prior to viability, by restricting funding available to patients and by requiring patients to wait a mandatory time period before having a procedure. Genetic counselors are trained to provide unbiased, comprehensive information in a non-directive style in order to allow patients to exercise their reproductive freedom. We developed a survey of 37 questions for genetic counselors to gauge the potential impact these provisions will have on their ability to be a patient advocate. A total of 286 individuals completed the survey; however, not all respondents answered all questions. Qualitative questions complemented quantitative survey entries, allowing respondents to input thoughts and examples. Results indicate genetic counselors in all regions share similar professional opinions about the provisions. More genetic counselors in the South and Midwest noticed changes impacting patients since the provisions have been enacted. These regional differences correlate with the location of states that have seem the greatest increase in antiabortion provisions.