Analyzing communication in genetic consultations--a systematic review

Abstract

Objective: To systematically review studies that have analyzed communication within medical consultations involving genetic specialists and report on their findings and design.

Methods: Drawing from PRISMA and appropriate guidelines for reviewing qualitative research, a systematic search of seven databases was conducted, followed by selection of studies for inclusion based on a set of criteria. Three authors conducted data extraction and narrative synthesis.

Results: Twenty-two studies were identified and were heterogeneous in setting, design, and methods, with many including limited descriptions of health professionals involved. Despite this variability, studies generally pursued the following three main objectives: searching for structural patterns within consultations, investigating communication and genetic counseling concepts, and linking process with input- and outcome-measures. Structural patterns identified included clinician dialog dominating consultations, and talk being mostly biomedical. Counseling and communication concepts investigated were: risk communication, the negotiation of power and knowledge, and adherence to genetic counseling ideals. Attempts to link consultation data to input- or outcome-measures were often unsuccessful.

Conclusion: More interdisciplinary research, grounded in appropriate theoretical frameworks, is needed to explore inherent complexities in this setting.

Practice implications: Findings from this review can be used to guide the design of future research into the process of genetic consultations.

Keywords: Discourse analysis; Genetic counseling; Medical communication; Medical genetics; Narrative synthesis; Physician–patient relations; Qualitative research; Quantitative research; Systematic review.