Gene mission impossible

GENETIC counselling is rarely neutral, with counsellors most likely to offer solutions to patients of low socio-economic status, a survey shows, writes Julia Hinde.

The survey was designed to see whether non-directive genetic counsellors fulfil their brief to inform but not advise on issues such as the chances of passing on genetic diseases to children.

The study was done by a team at the United Medical and Dental Schools of Guy's and St Thomas's, London and the Department of Medical Genetics at Addenbrooke's Hospital, Cambridge.

Transcripts from 131 genetic counselling sessions were studied. The results show that non-directiveness, considered an aim of counselling, is not the norm, with half of patients who faced a decision feeling steered by their counsellor. An average 5.8 advice statements were offered by a counsellor during a consultation. None of the 11 counsellors monitored rated their counselling style as "not at all" directive.

A research team spokesman said that non-directiveness was a purist goal "whose absolute achievement is probably impossible and possibly undesirable".

He added that there was no correlation between client satisfaction and directiveness and that even where patients were aware that the counsellor had an opinion, they did not feel pressure on their own decisions.