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PubMed1977

[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↗
PubMedDate not supplied

Effect of training and a structured office practice on physician-delivered nutrition counseling: the Worcester-Area Trial for Counseling in Hyperlipidemia (WATCH).

We examined the effectiveness of a training program for physician-delivered nutrition counseling, alone and in combination with a structured office practice environment for nutrition management, on physicians' counseling practices. Forty-five primary care internists and 1,278 of their patients in the top quarter of the cholesterol distribution at a central Massachusetts health maintenance organization (the Fallon Clinic) were enrolled into a randomized controlled trial. Physicians were randomized by site into three conditions: (1) usual care, (2) physician nutrition counseling training, and (3) physician nutrition counseling training plus a structured office practice environment for nutrition management (prompts and the provision of lipid results and counseling algorithms). A randomly selected 325 patients were given a 10-item patient exit interview (PEI) assessing whether the physician provided advice; assessed past changes, barriers, and resources; negotiated specific plans and goals; provided patient materials; referred the patient to a dietitian; and developed plans for follow-up. Condition 3 physicians demonstrated significantly greater implementation of the nutrition counseling sequence than did physicians in either of the other two conditions (P < .0001). Referrals to nutrition services were markedly reduced in condition 2, despite PEI scores no different than those in condition 1. Higher PEI scores for patients seen by physicians in condition 3 were stable for as long as two years beyond training. Primary care internists, when provided with both training in counseling techniques and a supportive office environment, will carry out patient counseling appropriately. Training alone, however, is not sufficient and may be counterproductive. Medical Subject Headings (MeSH): hypercholesterolemia, diet therapy, coronary disease, health behavior, primary health care, medical education, managed care programs.

Adult↗
PubMed2001

Saturated fat intake is reduced in patients with ischemic heart disease 1 year after comprehensive counseling but not after brief counseling.

OBJECTIVE: To examine the dietary habits of patients with ischemic heart disease 1 year after they received either dietary advice on using the Plate Model and how to increase intakes of fruits and vegetables in a 10-minute session (brief counseling group, BCG) or dietary advice primarily based on the National Cholesterol Education Program Step I diet provided in 2 individually tailored 50-minute sessions held 3 months apart (comprehensive counseling group, CCG). DESIGN: A randomized study that included dietary intake evaluation on basis of 7-day weighed food records completed at 3 occasions: immediately before counseling (week zero), 12 weeks after counseling, and 52 weeks after counseling. SUBJECTS: BCG was composed of 15 men and 2 women and CCG was composed of 16 men and 3 women with ischemic heart disease age 70 years or younger recruited from the Department of Cardiology, Odense University Hospital, Odense, Denmark. STATISTICAL ANALYSES PERFORMED: ANOVA, unpaired t tests, and multiple regression analysis, as well as nonparametric statistical analyses were carried out. RESULTS: The comprehensive counseling resulted in significant improvements from week 0 to 52 in the percent of energy from fat (33% to 28%), saturated fat (12% to 9%) and carbohydrate (51% to 54%) consumed by the subjects. The corresponding values in BCG did not differ significantly (31% to 32%, 11% to 12%, 53% to 52% respectively). Differences from week 0 to 52 between groups were significant for fat, saturated fat, and carbohydrate intake. In CCG, median intakes of fish, fruits, and vegetables were 44 g/day, 172 g/day, and 315 g/day, respectively, at week 52. The corresponding values in BCG were 44 g/day, 129 g/day, and 224 g/day. There was no significant difference either within or between the groups. CONCLUSION: This study suggests that sustained improvements in dietary behavior require individualized and reinforced counseling in patients with ischemic heart disease. Changes in intakes of fish, fruits, and vegetables need to be specifically targeted.

Aged↗
PubMed2002

Models of genetic counseling and their effects on multicultural genetic counseling.

This theoretical paper examines challenges to multicultural genetic counseling, counseling between culturally different clients and counselors, in the context of Kessler's typology of models of genetic counseling (Kessler S (1997) J Genet Counsel 6:287-295). It is suggested that challenges such as resistance to multicultural genetic counseling education may be due to conceptions about genetic counseling as a biomedical field that transcends questions of culture as well as lack of multicultural training or prejudice. Directions for future research and recommendations for multicultural genetic counseling education are briefly explored.

Cultural Diversity↗
PubMed1981

Genetic counseling for beta-thalassemia trait following health screening in a health maintenance organization: comparison of programmed and conventional counseling.

Providing adequate counseling of patients identified in genetic screening programs is a major responsibility and expense. Adults in a health maintenance organization, unselected for interest, were screened for beta-thalassemia trait as part of preventive health care. Counseling was provided by either a trained physician (conventional counseling) or by a videotape containing the same information followed by an opportunity to question a trained physician (programmed counseling). Immediately before and after counseling, knowledge of thalassemia, knowledge of genetics, and mood change were assessed by questionnaire. Comparable mood changes and similar learning about thalassemia and genetics occurred with both counseling methods. Thus, as judged by immediate effects on knowledge and mood, videotaped instruction can greatly reduce professional time required for genetic counseling and facilitate the incorporation of genetic screening into primary health care.

Adult↗
PubMed2004

Changes in multiple health outcomes at 12 and 24 weeks resulting from 12 weeks of exercise counseling with or without dietary counseling in obese adults.

OBJECTIVE: We compared health outcomes in obese adults who underwent 12 wk of exercise counseling with or without dietary counseling, followed by 12 wk of observational monitoring. METHODS: Ninety adults (77 women and 13 men; 42.6 +/- 6.0 y; body mass index, 31.5 +/- 2.8 kg/m(2)) were randomly assigned to exercise-only (EX) or diet-plus-exercise (DEX) groups and counseled weekly by exercise physiologists on a 12-wk walking program. DEX subjects were also counseled by dietitians on a hypocaloric diet (-500 kcal/d). From weeks 12 to 24, subjects were monitored but not counseled. At weeks 0, 12, and 24, data collection included body composition (air displacement plethysmography), fitness (maximum oxygen consumption, 3-min step-test, and timed mile), plasma lipids, weight loss efficacy (Weight Efficacy Life-Style Questionnaire), quality of life (Medical Outcomes Study Health Survey-Short Form 36), and mood (Profile of Mood States). RESULTS: At 12 and 24 wk, weight and body mass index decreased in DEX subjects (both P < 0.05) but not in EX subjects. However, lean body mass increased significantly in EX (24 wk, P < 0.05) but not in DEX subjects. In both groups, fat mass decreased (P < 0.05 for EX subjects at 24 wk; P < 0.05 for DEX subjects at 12 and 24 wk) and waist circumference decreased (P < 0.05 for EX subjects at 12 and 24 wk; P < 0.05 for DEX subjects at 12 and 24 wk). At 12 and 24 wk, DEX subjects showed decreased levels of total plasma cholesterol and triacylglycerols (both P < 0.05) and improvements with regard to the Weight Efficacy Life-Style Questionnaire (P < 0.05), three domains of the Medical Outcomes Study Health Survey-Short Form 36 (all P < 0.05), and three domains of the Profile of Mood States (all P < 0.05) that were not seen in EX subjects. CONCLUSIONS: Exercise counseling for 12 wk in obese adults improves some body composition indices that can be sustained over 12 wk of monitoring. The addition of dietary counseling increases improvements in body composition, lipid profiles, and several psychological parameters.

Adult↗
PubMed1999

Effect of physician-delivered nutrition counseling training and an office-support program on saturated fat intake, weight, and serum lipid measurements in a hyperlipidemic population: Worcester Area Trial for Counseling in Hyperlipidemia (WATCH).

OBJECTIVE: To evaluate the effectiveness of a training program for physician-delivered nutrition counseling, alone and in combination with an office-support program, on dietary fat intake, weight, and blood low-density lipoprotein cholesterol levels in patients with hyperlipidemia. PARTICIPANTS AND METHODS: Forty-five primary care internists at the Fallon Community Health Plan, a central Massachusetts health maintenance organization, were randomized by site into 3 groups: (1) usual care; (2) physician nutrition counseling training; and (3) physician nutrition counseling training plus an office-support program. Eleven hundred sixty-two of their patients with blood total cholesterol levels in the highest 25th percentile, having previously scheduled physician visits, were recruited. Physicians in groups 2 and 3 attended a 3-hour training program on the use of brief patient-centered interactive counseling and the use of an office-support program that included in-office prompts, algorithms, and simple dietary assessment tools. Primary outcome measures included change at 1-year of follow-up in percentage of energy intake from saturated fat; weight; and blood low-density lipoprotein cholesterol levels. RESULTS: Improvement was seen in all 3 primary outcome measures, but was limited to patients in group 3. Compared with group 1, patients in group 3 had average reductions of 1.1 percentage points in percent of energy from saturated fat (a 10.3% decrease) (P = .01); a reduction in weight of 2.3 kg (P<.001); and a decrease of 0.10 mmol/L (3.8 mg/dL) in low-density lipoprotein cholesterol level (P = .10). Average time for the initial counseling intervention in group 3 was 8.2 minutes, 5.5 minutes more than in the control group. CONCLUSION: Brief supported physician nutrition counseling can produce beneficial changes in diet, weight, and blood lipids.

Adult↗
PubMed2005

Genetic counseling for BRCA1/2: a randomized controlled trial of two strategies to facilitate the education and counseling process.

Due to the complexity of information surrounding BRCA1/2 counseling and testing and its time consuming nature, efforts to facilitate the genetic counseling and education process are needed. Using a 2 x 2 factorial design, two strategies were examined: a CD-ROM program for patients and a feedback checklist to the genetic counselor on patients' prior misconceptions. A total of 197 women attending a breast and ovarian cancer risk evaluation clinic for BRCA1/2 counseling were randomized into one of four conditions: standard care, CD-ROM only, feedback to counselor only, and both CD-ROM and feedback. Counseling outcomes included face-to-face time with the genetics team, knowledge acquisition, changes in worry about having a gene mutation, and genetic testing decisions. Overall, women who viewed the CD-ROM spent less time with the genetic counselor and were less likely to undergo genetic testing compared to women who did not view the CD-ROM. Feedback to the genetic counselor resulted in greater gains in knowledge of genetics and breast cancer. Among women less worried at baseline, those who viewed the CD-ROM showed no changes in worry following genetic counseling, in contrast to those who did not view the CD-ROM who increased in worry over time. This latter finding raises concerns about the impact of the increased worry on genetic testing decisions. No interaction effects of the two intervention arms were found. The study results support the importance of both strategies as valuable supplements to clinical BRCA1/2 counseling.

Adult↗
PubMed2005

Genetic counseling outcomes: perceived risk and distress after counseling for hereditary colorectal cancer.

Genetic counseling may turn risk information into cancer prevention behavior by modifying health beliefs and cancer-related distress. We assessed the effect of genetic counseling on these factors in 101 adult first-degree-relatives of colorectal cancer patients from families with known or suspected hereditary nonpolyposis colorectal cancer. Before counseling and once afterward, subjects completed self-report measures of perceived lifetime risk and cancer-distress. Most persons overestimated their cancer risk, and higher perceived risk was associated with believing that colorectal cancer cannot be prevented. Individual perceived risk changed after counseling, although mean perceived risk was unchanged. After adjusting for baseline risk, older persons and those with higher estimated objective cancer risk had larger postcounseling decreases. Distress after counseling was positively correlated with baseline distress and anxiety symptoms, and inversely correlated with tolerance for ambiguity. The findings suggest counseling interventions that should increase the likelihood of screening and offer hypotheses for future research.

Adaptation, Psychological↗
PubMed1995

Pre-marital genetic counselling to consanguineous couples: attitudes, beliefs and decisions among counselled, noncounselled and unrelated couples in Israel.

Semi-structured interviews were conducted with 65 Israeli subjects who received genetic counselling while considering marriage to a close relative, 40 subjects married to a close relative who did not receive pre-marital genetic counselling, and 125 controls married to a nonrelative and never having considered marrying a relative. It was found that 72% of the consanguineous couples who received pre-marital genetic counselling proceeded with their plans and married their relative; 86% of them reported that the counselling influenced their final decision to some degree. Counsellees' appraisals of genetic counselling revealed unfulfilled expectations to obtain more definitive answers, and mixed reactions to the nondirective approach applied by the counsellors. Comparisons between consanguineous and control couples revealed different views about consanguinity in general, and genetic risks in particular. Consanguineous couples, unlike controls, perceived consanguinity as an ordinary form of marriage, and had more favorable attitudes towards it. Compared to the noncounselled consanguineous group, consanguineous couples who received pre-marital genetic counselling had fewer children, estimated their genetic risk as lower but its subjective significance as higher, and perceived genetic disorders as more severe. The implications of these results are discussed from both theoretical and practical standpoints.

Attitude to Health↗
PubMed1998

What is counseling all about--basics in the counseling of health-related physical activity.

Counseling is presented as a professional approach in health care to promote physical activity in personal contacts. General principles of counseling are introduced with emphasis on client-centeredness, cooperative role relations, unconstrained interaction, and goal-oriented proceeding. The contacts with the clients or the patients are divided into three categories with different preconditions for the extent to which counseling methods can be applied and demands placed on the practitioner's counseling skills: 1, On the spot information and advice within a single contact; 2, Preplanned way of proceeding within a few repeated contacts touching the same topic; 3, Planned period of proper counseling sessions. Implications for counseling in physical activity are given.

Adult↗
PubMed2002

HIV counselling and testing in rural Uganda: communities' attitudes and perceptions towards an HIV counselling and testing programme.

Study results on the assessment of a community-wide HIV counselling and testing programme are presented. The aim of this qualitative study was to elucidate whether HIV counselling and testing (HIV CT) was acceptable to a rural community and whether they expressed a need for it. From a total of 2,267 persons of Kigoyera Parish, western Uganda, who were HIV tested and counselled, 171 persons participated in 17 focus group discussions. Most participants expressed a strong need for HIV counselling and testing services. The counsellors were seen as competent and confidential. Community health workers were favoured as the preferred provider of HIV CT services. However, participants stressed that they should not come from the same community. Most participants felt that a HIV CT programme available only once is not enough and did not induce a change in sexual behaviour, e.g. increased condom use. They requested counselling services that are continuously offered. The study results also showed that there is a demand for HIV counselling services without being HIV tested.

Adult↗
PubMed2001

Psychological aspects of genetic counseling. XIV. Nondirectiveness and counseling skills.

The difficulties some professionals have in achieving nondirective goals is largely due to the inadequate and ineffective application of basic counseling skills. The "new genetics," with its emphasis on decision-making in association with genetic testing, is among the most demanding forms of personal counseling, the effectiveness of which depends largely on the professional's human experience and counseling abilities. Examples are given showing inadequacies in professional responses to clients in genetic counseling which, in turn, defeat the achievement of a nondirectiveness that is helpful to clients, supports their self-directedness, and leaves them more psychologically prepared for quality decision making. Other models of counseling (e.g., shared decision making) will not fare any better than the nondirective one unless counseling skills of professionals in genetic services are upgraded in a significant way. Professional organizations need to give greater attention to the training and postgraduate supervision of all personnel involved in genetics services.

Decision Making↗
PubMed2006

Effectiveness of drug and alcohol counselling during methadone treatment: content, frequency, and duration of counselling and association with substance use outcomes.

AIMS: The study investigates the relationship between the type and severity of drug and alcohol use problems, and the provision of drug- and alcohol-counselling in methadone programmes. The study also specifically investigates the relationship between content, frequency and duration of counselling provided during the first month of treatment, and heroin, cocaine, and alcohol use outcomes at 6 months. DESIGN, SETTING AND PARTICIPANTS: The sample comprised 276 patients receiving outpatient methadone treatment who were followed-up 6 months after treatment entry. MEASUREMENTS: Data on client characteristics, drug and alcohol problems and on counselling received were collected by structured face-to-face interviews. FINDINGS: Drug-focused counselling was associated with less frequent heroin and cocaine use at follow-up, but was not related to pre-treatment drug use. Alcohol-focused counselling was provided for those with higher levels of drinking at admission but was not significantly associated with drinking outcome at 6 months. CONCLUSIONS: Results indicate that there are complex interactions between presenting substance use problems, provision of counselling and treatment outcomes. These interactions differ by substance type.

Adult↗
PubMed1988

Evaluation of genetic counselling: recall of information, post-counselling reproduction, and attitude of the counsellees.

Of the families who had received genetic counselling between 1972 and 1981, 791 replied to a questionnaire which covered recall of information, post-counselling reproduction and attitudes towards counselling and prenatal diagnosis. Eighty percent had adequate knowledge of mode of inheritance and 74% of recurrence risk. Knowledge of mode of inheritance was poorest in multifactorial transmission (63%) and knowledge of recurrence risk in X-chromosomal disorders (61%). Forty-five per cent of the families had started a pregnancy after the counselling. 25%). Early lethality of the disorder and feasibility of a prenatal study contributed to positive reproductive decisions. Nine per cent of the children born after the counselling were affected by the disorder in question. The observed risks tended to match well with the expected ones. Sixty-two per cent of the respondents felt that the counselling had had a great or moderate impact on their reproductive plans. Forty-two per cent expressed a wish to hear the counsellor's opinion in addition to the facts. This was more common when the disorder was severe. Although most couples (53%) wished to have a prenatal study, if feasible, and abort an affected foetus, 16% were against abortion in such a case and 31% wished to have the study but were ambiguous about an abortion.

Evaluation Studies as Topic↗
PubMed1995

Genetics in cancer prediction, screening, and counseling: Part II, The nurse's role in genetic counseling.

PURPOSE/OBJECTIVES: To describe an expanded role for oncology nurses in genetic counseling for cancer. DATA SOURCES: Published professional articles, computerized data bases, lay publications. DATA SYNTHESIS: A description of the availability of genetic counseling, of motivation for undergoing genetic counseling, and of the basic components of genetic counseling for cancer. CONCLUSIONS: The need for genetic counseling will increase as more families with inherited cancer are identified, more cancer genes are isolated, and genetic analysis becomes more available. IMPLICATIONS FOR NURSING PRACTICE: Advances in genetic technology provide nurses with the opportunity for an expanded role in genetic counseling for cancer. Oncology nurses also can act as case finders of families with inherited cancers and conduct research in this area.

Genetic Counseling↗
PubMed1993

[Counseling role of district nurses and district assistant nurses. A descriptive and evaluative study of the extent and intensity of counseling].

In nursing literature no consensus exists on the phenomenon 'counseling'. A literature search of the concept 'counseling' makes clear that it is possible to distinguish two dimensions of the concept 'counseling', namely 'range' and 'intensity' of counseling. These two dimensions are the starting point of this study. The main purpose of this study is to gain insight in the range and intensity of the counseling given by district nurses and district assistant nurses. This article aims to discover how often psychosocial nursing problems are recognized and how often nursing interventions are executed by nurses, and with how many patients this was done. The research is designed as a secondary analysis. We used data collected by Wiersma et al. (1991). The results confirm earlier research but also offer new points of view. The study confirms that counseling is an essential aspect of district nursing. Some (significant) differences were discovered between district nurses and district assistant nurses in the psychosocial care that was given. Factors like level of education, patient population and organization will probably explain the differences between the two professional groups. This aspect of the study needs further inquiry.

Adult↗
PubMed2003

Telephone counselling for adolescent suicide prevention: changes in suicidality and mental state from beginning to end of a counselling session.

Telephone counselling is an accessible and confidential means by which distressed young people can seek help. Telephone counselling services were funded under Australia's National Youth Suicide Prevention Strategy between 1997 and 2000. In this study, the effectiveness of telephone counselling for young people seeking help in the context of suicidal ideation or intent was evaluated in an investigation of calls made by suicidal young people to a telephone counselling service. Independent raters measured callers' suicidality and mental state at the beginning and end of 100 taped counselling sessions. Changes in suicidality and mental state were measured using a reliable rating scale developed for the study. Significant decreases in suicidality and significant improvement in mental state were found to occur during the course of counselling sessions, suggesting positive immediate impact. Limitations of the study with respect to longer-term outcomes and the relevance of the results for suicide prevention are discussed. Notwithstanding the study limitations, the results lend support for continuing development of hotline services.

Adolescent↗