Providing space in genetic counseling: Reflexive thematic analysis of long and short sessions across clinical specialties

The duration of genetic counseling (GC) sessions can vary significantly. However, which factors contribute to sessions being abbreviated or extended and how that affects quality of care has not been well studied. This study explored variability in long versus short GC patient care time, defined as time spent in the session with the patient, across various specialties and settings. Sessions from the Genetic Counseling Processes Result in Outcomes (GC-PRO) study were purposively sampled based on session time to include nine short (45 min) sessions. Audio recordings of these 18 sessions were transcribed and then analyzed using a reflexive thematic coding approach according to Braun and Clarke, involving the study team familiarizing themselves with the data, coding and recoding, developing themes, revising and refining in relation to the coded data and then the full dataset. Four themes were generated: (1) genetic counselor behaviors influence session content and patient involvement, (2) patient behaviors vary based on levels of patient engagement and impact session direction, (3) patient characteristics are an opportunity for customized communication strategies, and (4) contextual factors impact patient care time and can be moderated via alternative information gathering approaches. This research suggests that GC sessions often involve substantial time spent gathering medical information and providing extensive information to patients (e.g., background information on genetics, genetic testing technologies) and genetic counselors engage patients variably with regard to questions and psychosocial prompts. Findings uncovered potentially modifiable factors-including the quantity of information provided, the extent of history collected, and unintentionally inhibiting patient questions-that may improve efficiency and, consequently, patient-centered care quality by providing more space for patients to engage, ask questions, and express emotions.