Piloting a standardized psychosocial assessment tool (BATHE) in genetic counseling

PROJECT ABSTRACT
Significant rates of psychological distress have been found in patients across a range of genetic counseling
settings, including cancer, cardiology, prenatal and medical genetics. In many cases, these needs are profound
and unmet. Such data suggest that genetic counselors providing clinical care should routinely assess patients’
emotions and psychological impact. Accreditation boards for genetic counseling require this skill to achieve
certification, but there is no standard definition of a “psychosocial assessment” in genetic counseling nor
universal instruments to facilitate it. Those tools that do exist are questionnaire-based or specific to a clinical
indication, eg. hereditary cancer. We can look to other healthcare settings, such as social work and primary
care, to borrow tools which standardize the psychosocial assessment and which may be applicable in genetic
counseling. One such tool developed in primary care is the BATHE method: a structured technique consisting
of four questions that explore patients’ main presenting concerns, emotional affect and coping, paired with
guidance for empathic responses. Evidence from the primary care literature shows the BATHE method reduces
patient anxiety and improves patient empowerment. Providers find it concise and easy-to-learn, allowing for a
person-centered interaction without increasing consultation time. These characteristics combined make it an
attractive tool to pilot in genetic counseling, which provides patient-centered care while balancing information
delivery and support. For these reasons, we request funding through this NHGRI R21 mechanism to better
characterize the current state of psychosocial practices and pilot an innovative standardized way to provide
such an assessment in genetic counseling. These goals are in line with the NHGRI’s 2020 Strategic Vision to
promote patient empowerment around genomic information and train a workforce that is scalable and efficient.
First, this study will describe the current practices of psychosocial assessments in genetic counseling, using
descriptive content analysis of transcripts of a purposive sample of genetic counseling sessions at Stanford
Medicine. Second, this study will pilot a psychosocial assessment tool (the BATHE method) in genetic
counseling to assess its feasibility and acceptability by genetic counselors. Exploring patients’ perspectives,
patient-related outcomes, and influence of cultural differences are crucial, and the current study lays the
groundwork for this subsequent research. At the conclusion of our study, the findings from our aims will inform
the development of a genetic counseling-specific standardized psychosocial assessment. The ultimate goal of
this research is to build a foundation for investigation of patient outcomes in response to psychosocial
counseling approaches.

Grant Number: 5R21HG012436-03
NIH Institute/Center: NIH
Principal Investigator: Maryann Campion