The Health Relationship in the context of genetic Counselling: The communication of risk and decision making processes

The prenatal or preconception genetic counseling may represent a key step for those who cope with reproductive choices in genetic risk situations (Kessler, 1997; Uhlmann, Schuette and Yashar, 2009; Freda, Zaccaro, Gleijeses and Politano, 2010). Over the last four decades, advances in genetic knowledge and the opportunities for geneticist to learn about their genetic risk have led to renegotiate notions, such as health and illness and, specifically, the conception of life and procreation which have several implications in ethical issues and in clinical practice. The current investigation focuses on ultimate experience of genetic counselling in prenatal or preconception setting. The aim is to explore the processes of significance about the consequences of communication of risk within one month to the end of genetic counseling intervention in order to hypothesize research-intervention projects which involve medical and psychological profession in a joint setting. Participants are all attending Cardiomyology and Medical Genetics counseling in Naples (Italy) for the first time. Transcripts of 18 semi-structured interviews were conducted and then analysed by Interpretative Phenomenological Analysis (Smith, 2004; Smith, Flowers and Larkin, 2009). Through this approach, three super-ordinate themes were identified: the familiar outcomes of genetic counselling; the representation of risk and the vicissitudes of decision-making. In prenatal and reproductive scenarios, we hypothesize the sole choice to request genetic counseling can have several consequences on family and inter-/intra-generational ties. In such context, the counselor???s task is to introduce the information as a new source of sense-making and to accompany the use of this information so that the proband???s personal sense of control became more powerful, in managing the decision-making processes. In our opinion, the psychological function can play a central role in an integrated perspective with the medical function. As discussed in other articles (Zaccaro and Freda, 2011; 2012), we wish that the psychologist could take part in the whole temporal context of the process of genetic counseling (pre-test, test, post-test, follow-up) (Laurent, Croupier and Pujol, 2006; Léger, Dauchy and Chompret, 2006) and that, from the pre-counseling step to the follow-up, could contribute to the achievement of protecting and promoting health (Bertini, 2004).