Current Situation And Influencing Factors Of Shared Decision-making In Genetic Counseling

Objective:(1)To understand the current situation of shared decision-making in genetic counseling.(2)To explore the influencing factors of shared decision-making in genetic counseling.Methods: This study adopted a convergent parallel mixed method to collect quantitative and qualitative data.And a comparative analysis was made for those results.(1)For quantitative study,a cross-sectional survey was used to investigate eligible genetic counselees in the Genetics Department of CITIC Xiangya Specialist Hospital for Reproduction and Genetics in Changsha from August 2021 to January 2022.The study instruments included the general information questionnaire,the Control Preference Scale,Preparation for Decision-making Scale,9-item Shared Decision Making Questionnaire and the Decision Conflict Scale.The SPSS26.0was used for statistical description,consistency analysis,correlation analysis,univariate analysis and ordered logistic regression analysis.(2)For qualitative study,semi-structured interviews were conducted with genetic counselors,genetic nurses and genetic counselees,and the materials collected were coded and collated with Nvivo11.And the Colaizzi seven-step analysis method was used to analyze the interview data.Results: A total of 223 valid questionnaires were collected and 20semi-structured interviews were conducted in this study.(1)In terms of the current state of genetic counseling decision-making style,61.9% participants expected a shared decision-making style,and56.5% perceived the same style after genetic counseling.The expected and perceived decision-making styles had a general consistency with a Kappa coefficient of 0.389.The Preparation for Decision-making score was(67.43±19.3)and the primary source of the preparation data was online knowledge.The 9-item Shared Decision Making Questionnaire scored(86.02±14.81),which showed the high level of shared decision-making.All of the genetic counselors,genetic nurses and genetic counselees showed more preference in shared decision-making.The Decisional Conflict Scale score was(19.96±13.52),which was a mild degree of decisional conflict.(2)Correlation analysis indicated that scores on the 9-item Shared Decision Making Questionnaire were positively correlated with the Preparation for Decision-making Scale scores(r=0.326,P<0.001)and negatively correlated with the Decision Conflict Scale scores(r=-0.611,P<0.001).(3)As to the influencing factors of shared decision-making in genetic counseling,the univariate analysis showed that differences between the level of shared decision-making were reflected in the counselee’s marital status(Z=-4.038,P<0.000),educational level(H=7.067,P=0.029)and the presence of children(Z=-2.538,P =0.011).The results of the ordered logistic regression analysis showed that the independent factors of shared decision-making were: marital status(OR=0.023,95% CI=0.001-0.476,P=0.015),educational level(OR=0.243,95% CI=0.084-0.701,P=0.009),the presence of children(OR= 0.134,95% CI=0.027-0.675,P=0.015),the Preparation for Decision-making score(OR=1.035,95% CI=1.005-1.066,P=0.022),and the Decision Conflict score(OR=0.912,95%CI=0.87-0.957,P=0.001).Of these,unmarried,uneducated,without children,and high level of decisional conflict were independent barriers while well prepared for decision-making were independent facilitators of shared decision making in genetic counseling.After analysing the qualitative data,three influencing factors themes were identified of shared decision-making in genetic counseling,namely:genetic counselee factors,genetic practitioner factors and genetic counseling process factors.Among them,the genetic counselee factor includes subthemes such as educational level,age and social status;the genetic practitioner factor includes subthemes such as communication skills and empathy;and the genetic counseling process factor includes subthemes such as the preparation of decision-making,family involvement and time.Conclusions:(1)The results of this research showed,there was a high level of shared decision-making,with genetic counselors,genetic nurses and counselees having positive attitudes of shared decision-making.(2)The level of shared decision-making in genetic counseling was influenced by three aspects: genetic counselee,genetic counseling practitioner and genetic counseling process.In the future,multi-center studies in different types and levels of hospitals and community health centers can be conducted.These may be considered to improve the standard of medical services in China.