Counseling Encounters Research Articles

Counseling About Cannabis Use During Pregnancy and Lactation: A Qualitative Study of Patient and Clinician Perspectives.

Legalization in many jurisdictions has increased the prevalence of cannabis use, including during pregnancy and lactation. Accordingly, clinicians providing perinatal and infant care are increasingly required to counsel about this topic, even if they do not feel comfortable or prepared for this conversation. The aim of this research was to explore how prenatal clinicians and pregnant and lactating women interact with cannabis consumption. Using qualitative description, we conducted semi-structured interviews with 75 individuals in Canada: 23 clinicians who provide pregnancy and lactation care, and 52 individuals who made cannabis consumption decisions during pregnancy and/or lactation. Data were analyzed using inductive content analysis. Three phases of the clinical encounter influenced decision-making about cannabis consumption: initiation of a discussion about cannabis, sense-making, and the outcome of the encounter. Patients and clinicians described similar ideals for a counseling encounter about cannabis consumption during pregnancy or lactation: open, patient-centered conversation grounded in an informed decision-making model to explore the benefits, risks, and alternatives to cannabis. While clinicians described these values as reflecting real clinical interactions, patients reported that in their experience, actual interactions did not live up to these ideals. Clinicians and pregnant and lactating people report desiring the same things from a counseling interaction about cannabis: sharing of information, identification of values, and facilitation of a decision. Both groups endorse an open, nonjudgemental counseling approach that explores the reasons why a patient is considering cannabis consumption and reflects these reasons against available evidence and alternatives known to be safe.

Abstract 7333: From provider discussion to test completion: Evaluating cancer genetic services in a diverse academic comprehensive cancer care population

Abstract Objective: Genetic testing (GT) and counseling (GC) are important aspects of comprehensive cancer care, yet persistent equity challenges exist. We aim to characterize the evolving utilization of GT and GC services for potential hereditary breast, ovarian, pancreatic, and prostate cancers (HBOPP). Methods: We performed a retrospective single-institution chart review of a balanced racial subset of HBOPP patients who met National Comprehensive Cancer Network (NCCN) criteria diagnosed from 2019-2013. Data were analyzed using chi-squared test and multivariable logistic regression. Results: 503 HBOPP patients were studied. GT was discussed with 50.5% (n=254) of patients, 42.3% (n=213) completed GT, but only 8.7% had GC (n=44) (Table 1). Patients who were younger, had managed care, or had a family history of cancer were significantly more likely to have a GT discussion and complete GT (all p<0.01). Pancreatic cancer (RR 0.11; 95% CI 0.05-0.21) and prostate cancer patients (RR 0.05; 95% CI 0.02-0.10) were less likely to have a GT discussion with their provider than breast cancer patients. HBOPP patients had a lower likelihood of having a GT discussion with each additional year of age at diagnosis (RR 0.95; 95% CI 0.93-0.98). Among patients who had a GT discussion, prostate cancer patients (RR 0.14; 95% CI 0.04-0.47) and Black patients (RR 0.25; 95% CI 0.09-0.71) were less likely to complete GT. Ovarian cancer patients (RR 12.1; 95% CI 5.19-28.5) and patients with a family history of cancer (RR 2.26; 95% CI 1.05-4.86) were more likely to have GC. Conclusions: Inequities persist in GT and GC. NCCN-eligible patients who were older or had prostate or pancreatic cancer were less likely to have GT discussion. We found that Black patients were less likely than White patients to complete GT. GC rates were low across all groups except patients with ovarian cancer. Multilevel and systemic interventions are needed to improve equity in cancer genetic services. Access to, completion, and outcomes of genetic testing and counseling, by cancer type. Breast (n=212) Ovarian (n=48) Pancreatic (n=105) Prostate (n=138) Total (n=503) Test (p) Was there evidence a provider discussed and/or offered genetic testing? Yes 172 (81.1%) 36 (75.0%) 26 (24.8%) 20 (14.5%) 254 (50.5%) <0.001 No 40 (18.9%) 12 (25.0%) 79 (75.2%) 118 (85.5%) 249 (49.5%) Is there any evidence that the patient received genetic testing? Yes 155 (90.1%) 32 (88.9%) 18 (69.2%) 8 (42.1%) 213 (84.2%) <0.001 No 17 (9.9%) 4 (11.1%) 8 (30.8%) 11 (57.9%) 40 (15.8%) What were the patients results? Mutation positive 25 (16.3%) 5 (15.6%) 2 (11.1%) 0 (0.0%) 32 (15.2%) 0.095 Mutation negative 83 (54.2) 12 (37.5%) 13 (72.2%) 3 (37.5%) 111 (52.6%) Variant of unknown significance 43 (28.1%) 13 (40.6%) 3 (16.7%) 4 (50.0%) 63 (29.9%) No info available/cannot find 2 (1.3%) 2 (6.2%) 0 (0.0%) 1 (12.5%) 5 (2.4%) Was there evidence of any genetic counseling encounter? No 195 (92.4%) 27 (57.4%) 102 (97.1%) 133 (96.4%) 457 (91.2%) <0.001 Yes 16 (7.6%) 20 (42.6%) 3 (2.9%) 5 (3.6%) 44 (8.8%) Citation Format: Ariana Naaseh, Hannah Rice, Isabel Temosihue, Natasha Zimmermann, Erin Linnenbringer. From provider discussion to test completion: Evaluating cancer genetic services in a diverse academic comprehensive cancer care population [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 7333.

Improving the quality of counseling and clinical supervision in opioid treatment programs: how can technology help?

BackgroundThe opioid epidemic has resulted in expanded substance use treatment services and strained the clinical workforce serving people with opioid use disorder. Focusing on evidence-based counseling practices like motivational interviewing may be of interest to counselors and their supervisors, but time-intensive adherence tasks like recording and feedback are aspirational in busy community-based opioid treatment programs. The need to improve and systematize clinical training and supervision might be addressed by the growing field of machine learning and natural language-based technology, which can promote counseling skill via self- and supervisor-monitoring of counseling session recordings.MethodsCounselors in an opioid treatment program were provided with an opportunity to use an artificial intelligence based, HIPAA compliant recording and supervision platform (Lyssn.io) to record counseling sessions. We then conducted four focus groups—two with counselors and two with supervisors—to understand the integration of technology with practice and supervision. Questions centered on the acceptability of the clinical supervision software and its potential in an OTP setting; we conducted a thematic coding of the responses.ResultsThe clinical supervision software was experienced by counselors and clinical supervisors as beneficial to counselor training, professional development, and clinical supervision. Focus group participants reported that the clinical supervision software could help counselors learn and improve motivational interviewing skills. Counselors said that using the technology highlights the value of counseling encounters (versus paperwork). Clinical supervisors noted that the clinical supervision software could help meet national clinical supervision guidelines and local requirements. Counselors and clinical supervisors alike talked about some of the potential challenges of requiring session recording.ConclusionsImplementing evidence-based counseling practices can help the population served in OTPs; another benefit of focusing on clinical skills is to emphasize and hold up counselors’ roles as worthy. Machine learning technology can have a positive impact on clinical practices among counselors and clinical supervisors in opioid treatment programs, settings whose clinical workforce continues to be challenged by the opioid epidemic. Using technology to focus on clinical skill building may enhance counselors’ and clinical supervisors’ overall experiences in their places of work.

Racial disparities in cancer genetic counseling encounters: study protocol for investigating patient-genetic counselor communication in the naturalistic clinical setting using a convergent mixed methods design

BackgroundDespite decades of effort to reduce racial cancer disparities, Black people continue to die at higher rates from cancer than any other U.S. racial group. Because prevention is a key to the cost-effective and long-term control of cancer, the potential for cancer genetic counseling to play a central role in reducing racial cancer disparities is high. However, the benefits of genetic counseling are not equitable across race. Only 2% of genetic counselors self-identify as Black/African American, so most genetic counseling encounters with Black patients are racially discordant. Patients in racially discordant medical interactions tend to have poorer quality patient-provider communication and receive suboptimal clinical recommendations. One major factor that contributes to these healthcare disparities is racial bias. Drawing on findings from prior research, we hypothesize that genetic counselor providers’ implicit racial prejudice will be associated negatively with the quality of patient-provider communication, while providers’ explicit negative racial stereotypes will be associated negatively with the comprehensiveness of clinical discussions of cancer risk and genetic testing for Black (vs. White) patients.MethodsUsing a convergent mixed methods research design, we will collect data from at least 15 genetic counseling providers, from two different institutions, and their 220 patients (approximately equal number of Black and White patients per provider) whose appointments are for a hereditary cancer condition. The data sources will include two provider surveys, two patient surveys, video- and/or audio-recordings of genetic counseling encounters, and medical chart reviews. The recorded cancer genetic counseling in-person and telehealth encounters will be analyzed both qualitatively and quantitatively to assess the quality of patient-provider communication and the comprehensiveness of clinical discussion. Those data will be linked to pre- and post-encounter survey data and data from medical chart reviews to test our hypotheses.DiscussionFindings from this multi-site study will highlight specific aspects of cancer genetic counseling encounters (patient-provider communication and clinical recommendations) that are directly associated with patient-centered outcomes (e.g., satisfaction, trust, genetic testing completion). Patient-provider communication and clinical recommendations are modifiable factors that can be integrated into current genetic counseling training curricula and thus can have immediate impact on genetic counseling training and practice.

Thanks for coming in, Ms. Wilson: A qualitative case study of simulated school counseling encounters

ABSTRACT This manuscript reports qualitative case study research with 10 school-counselors-in-training (SCITs). Using a single-case approach, researchers explored SCITs’ professional identity development through the implementation of an andragogical intervention using two simulated counseling encounters as part of a school counseling course. The results of this study produced an understanding of 10 SCITs’ evolving professional identity, counseling skills, and actions. Implications for school counselor training, counselor educators’ andragogy, research, and future simulations are discussed.

Choosing the best apple: counselling leaflets and technologies of communication in the history of reproduction

Historians have shown how the establishment of human genetic counselling in West Germany was characterised by several sociohistorical factors, in particular the impact of the legacies of Nazi biopolitics. These...

Contraceptive counseling in 2 urban cities in Ghana and the extent of shared decision-making

Increased use of contraception is associated with reduced maternal mortality worldwide; however, an unmet need remains high in many places, including Ghana. The quality of care provided by family planning practitioners influences contraceptive use; one way to improve the quality of care is to adopt a client-centered approach to counseling, including engaging in shared decision-making. In Ghana, little is currently known about the extent of shared decision-making between clients and providers in contraceptive counseling encounters. The purpose of this study was to explore the extent of shared decision-making during contraceptive counseling in 2 cities in Ghana. This was a cross-sectional study across 6 urban family planning clinics in Accra and Kumasi, Ghana. We recorded, transcribed, and analyzed 20 family planning patient-provider interactions using the "Observing PatienT InvOlvemeNt" (OPTION) scale. This scale has 12 domains, which are scored on a 5-point scale, from 0 ("the behavior is not observed") to 4 ("the behavior is observed and executed at a high standard"); the scores of each domain are summed up for a total score ranging from 0 to 48. In these encounters, the mean total scores for each interaction ranged from a low of 9.25/48 to a high of 21.5/48. Although providers were thorough in sharing medical information with clients, they did not actively involve clients in the decision-making process and did not generally elicit client preferences. Across the 12 domains, the mean total score was 34.7%, which is below the 50% that would correspond with a "baseline skill level," suggesting there are very low levels of shared decision-making currently occurring. In these 20 patient-provider encounters, counseling was mainly a sharing of medical information from the provider with the client, without the provider eliciting information from the client about her preferences for method characteristics, side effects, or method preference. Family planning counseling in these settings would benefit from increased shared decision-making to engage patients in their contraceptive choice.

Making the ‘genetic counsellor’ in the UK, 1980–1995

The professional identity of the ‘genetic counsellor’ first took shape in the UK in the early 1990s, when the University of Manchester established the country’s first masters-level training course. Postwar,...

A machine learning approach to identifying suicide risk among text-based crisis counseling encounters.

With the increasing utilization of text-based suicide crisis counseling, new means of identifying at risk clients must be explored. Natural language processing (NLP) holds promise for evaluating the content of crisis counseling; here we use a data-driven approach to evaluate NLP methods in identifying client suicide risk. De-identified crisis counseling data from a regional text-based crisis encounter and mobile tipline application were used to evaluate two modeling approaches in classifying client suicide risk levels. A manual evaluation of model errors and system behavior was conducted. The neural model outperformed a term frequency-inverse document frequency (tf-idf) model in the false-negative rate. While 75% of the neural model's false negative encounters had some discussion of suicidality, 62.5% saw a resolution of the client's initial concerns. Similarly, the neural model detected signals of suicidality in 60.6% of false-positive encounters. The neural model demonstrated greater sensitivity in the detection of client suicide risk. A manual assessment of errors and model performance reflected these same findings, detecting higher levels of risk in many of the false-positive encounters and lower levels of risk in many of the false negatives. NLP-based models can detect the suicide risk of text-based crisis encounters from the encounter's content.

Reproductive deliberation: Supporting autonomous decision making in prenatal genetic counseling.

As both the scope and popularity of non-invasive prenatal testing (NIPT) have expanded, debate has emerged about the extent to which this test enhances or undermines reproductive autonomy. Genetic counseling is crucial to support autonomy in the context of making complex and value-laden decisions about reproductive care following high-chance results from NIPT. Two models of post-test prenatal genetic counseling have been proposed; the first of these, non-directive counseling, is the predominant model, while shared decision making is an alternative model deriving from patient care for chronic conditions. In this paper, we argue that neither of these approaches is adequate for counseling after NIPT to support reproductive autonomy. Instead, then, we propose an alternative approach that we call reproductive deliberation. This approach to prenatal genetic counseling simultaneously recognizes the relationality of the counseling encounter and supports the decision making capacity and decisional responsibility of the pregnant person.

Single-center comparison of cancer genetics referral rates for patients with pancreatic cancer following implementation of a best practice advisory: A quality improvement project.

311 Background: Despite guidelines recommending germline genetic testing (GT) and genetic counseling for individuals with pancreatic ductal adenocarcinoma (PDAC), referrals remain suboptimal. This can have negative implications on treatment, particularly for patients with actionable mutations. This project aims to compare the referral rate to genetic services of MD Anderson Cancer Center at Cooper pre- and post-implementation of an electronic health record (EHR) physician best practice advisory (BPA) recommending a cancer genetics referral order for PDAC patients. Methods: Medical records, cancer genetics referrals (CGR), and germline and somatic testing results were retrospectively reviewed for patients with a PDAC diagnosis in 2019-2020, and prospectively for those diagnosed after BPA implementation from October 2021 through May 2022. The primary outcome was the rate of CGR, and the secondary outcomes were genetic counseling encounters and GT completion. Descriptive statistics were used for analysis. Results: Prior to BPA initiation, CGR were offered to 44 (24.3%) of 181 eligible patients with 39 (88.6%) of those accepting CGR. Germline testing represented 90.9% (30 patients) of the GT performed in the pre-BPA group. Post-BPA, CGR were offered to 23 (51.1%) of 45 eligible patients with 20 (86.95%) of those accepting CGR. Germline testing represented 100% (13 patients) of the GT performed in the post-BPA group. Conclusions: Only 24.3% of patients diagnosed with PDAC between 2019-2020 were referred to cancer genetics, showing that even after updated NCCN guidelines in 2018 the CGR rate remained low. Following BPA implementation, CGR increased to 51.1% over 8 months for newly diagnosed patients. Germline testing increased by 10%. These preliminary results show that implementing a physician BPA can increase CGR and germline GT, which could have positive implications on treatment. Limitations include a lack of a standardized referral process for the pre-BPA group and a limited timeframe to obtain GT for the post-BPA group.[Table: see text]

Empowering learners to provide dietary counselling.

Despite calls to increase dietary counselling by physicians to help address the epidemic of lifestyle-related chronic disease, medical education does not equip future physicians with the training to provide effective dietary counselling. In addition to the multiple barriers that clinician educators face in implementing clinically relevant nutrition education curricula, evaluation modalities in the nutrition education literature that assess student skills and behaviour remain limited. We implemented a brief, virtual nutrition education intervention in a US medical school during the outpatient clinical clerkship and assessed how our curriculum influenced students' development of dietary counselling skills. Student feedback revealed appreciation for learning how to approach conversations about diet in a non-judgmental manner and specific strategies to use during counselling. We thematically analysed the free-text responses from 81 dietary counselling encounter forms submitted by students. Three emergent themes reflected the key dietary counselling skills students demonstrated during patient encounters: (1) eliciting drivers of current eating patterns and barriers to healthier eating patterns, (2) individualising recommendations and (3) recommending evidence-based strategies. After receiving brief, clinically relevant, virtual nutrition education, students were able to successfully apply dietary counselling skills to patient care. In conjunction with indirect skill assessment through targeted documentation, we offer a sustainable approach for feasible nutrition education paired with meaningful evaluation.

Exploring United States genetic counselor and healthcare interpreter perspectives: Allocation of roles within the genetic counseling encounter.

Genetic counselors (GCs) and healthcare interpreters (HIs) are key members of the healthcare team when providing genetic counseling services to patients with Limited English Proficiency (LEP); however, the working relationship between GCs and HIs and the role each member plays within a genetic counseling session is unclear. Previous studies assessing this relationship have been qualitative and limited in sample size (Agather et al., 2018, Journal of Genetic Counseling, 26, 1388; Krieger et al., 2018, Journal of Genetic Counseling, 26, 1388; Lara‐Otero et al., 2019, Health Communication, 34, 1608; Rosenbaum et al., 2020, Journal of Genetic Counseling, 29, 352). This study utilized a quantitative approach to allow for sampling of larger populations and to simultaneously understand current perspectives of GCs and HIs regarding each other's and their own roles within a genetic counseling session. GC and HI participants from the United States were recruited via email to complete an online survey with questions regarding interactions prior to a session, roles during a session, and opportunities for collaboration and constraints in the working relationship. Descriptive and inferential statistics were utilized to analyze responses of GCs and HIs. 130 GC and 40 HI participants were included in this study. There were statistically significant differences (p < .001) in responses between GC and HI participants on the expected distribution of roles during a session in advocacy, psychosocial and cultural domains. Additionally, this study identified that HI desired resources and training regarding genetics and genetic counseling are currently not being met. To our knowledge, this is the largest study to simultaneously survey GC and HI perspectives on these topics. Our findings suggest the need for greater communication and collaboration between GCs and HIs to ensure high‐quality care for patients with LEP. Integrating a pre‐session meeting between the GC and HI for sessions with patients with LEP and increasing education for GCs and HIs on the roles each group brings into a session is warranted to optimize this collaborative relationship and patient care.

By the Renewal of Your Mind: Clinical and Theological Reflections on Racism and Anti-Racism

ABSTRACT For many white, Western European descendant-citizens of the United States who watched the horrific death of George Floyd and ensuing protests, the question of one’s racism has landed front and center in their consciousness in stark, new ways. This article offers a series of clinical and Christian theological reflections on the nature of race, racism, and anti-racism based on material gleaned from a series of clinical counseling encounters, including a verbatim from one particular session. The reflections include feedback from the Society of Pastoral Theology’s workshop I presented in June 2021. They are not intended to offer any exhaustive, definitive, proscriptive claims about race, racism, and anti-racism. Rather, the reflections are intended to be invitations to curiosity and to create avenues for future inquiry, particularly as it relates to pastoral counseling and the overall, ongoing formational work of raising consciousness around issues of race, culture, and ethnicity.

Elicitation of children's understanding of information in pediatric genetic counseling encounters: A discourse-oriented perspective.

Affirmation of children's understanding of information provided in genetic counseling encounters is crucial to obtaining children's informed consent/assent in pediatric genetic counseling encounters. It is also important for the proper management of a genetic condition. Currently, there is a relative scarcity of research on how understanding of complex genetic information by children is elicited in the process of pediatric genetic counseling. In this study, we apply theme-oriented discourse analysis to examine 23 video/audio-recorded genetic counseling encounters in Hong Kong. The encounters involve children aged between 3 and 17years old who are suspected to have or diagnosed with Sudden Arrhythmic Death Syndrome (SADS). Specifically, we examine a range of communicative strategies that genetic professionals employ to elicit children's understanding of information in this genetic counseling setting. We also examine how children's epistemic status is negotiated between genetic professionals, parents, and children. The study reveals that genetic professionals typically use direct questioning (e.g., "do you understand?" or "do you have any questions?"). Less typical are examples where genetic professionals explore children's epistemic access and invite children to recall information after they deliver it. The study reveals two discourse strategies that genetic professionals and parents employ to justify a child's low epistemic status: (1) construction of "current ignorance" and "future competence" in children and (2) association with a child's character. In the examined counseling encounters, genetic professionals and parents tend to construct a low epistemic status in younger children and allocate the responsibility for understanding relevant information to the parents and the "future" competent children. The study highlights the impact of genetic professionals' and parents' assumptions on children's knowledge and comprehensibility at different ages, and the role that children themselves play in conforming or contesting these assumptions.

Multicancer hereditary syndrome testing: Genetic counselors’ perspectives.

106 Background: The accessibility of cancer hereditary syndrome testing has increased, and the cost has declined significantly in the past few years. We conducted a national, quantitative survey of genetic counselors (GCs) to assess their perspectives on what influences hereditary cancer genetic testing decisions and practices, with a focus on cost. This survey was funded by NIH, conducted by UCSF TRANSPERS, and supported by the National Society of Genetic Counselors(NSGC). Methods: The survey was developed through literature review, expert interviews, and a pilot. Sent to the NSGC Cancer Special Interest Group via email. Chi-square tests were used to examine variability. Results: The survey response rate was 56% (202/363). Multiple hereditary cancer syndrome tests are discussed often/always by 86% of genetic counselors (GCs).The existence of an institutional protocol on multiple hereditary cancer syndrome testing was reported by 35.4% of GCs. When asked about GC counseling encounters, GCs report insurance rarely/never pays for: 25.2% pre-test in-person,39.7% for pre-test tele-genetics, 35.4% post-test in-person, and 52.9% post-test tele-genetics. GCs rated clinical factors higher than cost as influencing decision for multiple hereditary syndrome cancer testing (table); the total cost of the test was least important. These patterns were similar across the GCs institution types and years in practice. Conclusions: We found consistent use of multiple hereditary cancer syndrome tests, with less focus on cost, out-of-pocket, and insurance coverage and more of a focus on clinical indicators. GCs reported challenges with reimbursement for GC counseling encounters. The shift toward more genetic counseling encounters via tele-genetics necessitates evaluation of insurance reimbursement.[Table: see text]

Genetic counseling clinical documentation: Practice Resource of the National Society of Genetic Counselors.

Clinical documentation is an important extension of a genetic counseling encounter. The traditional types of clinical documentation include the clinical visit note (including follow-up visit note), letter to the referring physician, letter to the patient, and result summary to the patient and referring physician. Increasing patient volumes, new genetic counseling service delivery models, transition to electronic medical records (EMR), new specialty clinics in genetics, and advances in genetic testing technologies challenge the practice of writing multiple types of clinical documents. This practice resource (PR) seeks to provide best practices for U.S.-based genetic counselors to write efficient and comprehensive clinical documentation using a hybrid clinical document designed to facilitate communication between individual providers, providers, and patients/families, and providers and payers. The content of the hybrid clinical documentation will vary by genetic specialty but may include a summary of genetic services evaluation, genetic testing options and eligibility information, genetic test results, potential risks for genetic conditions, implications for family members, and medical management recommendations. An outline of a general hybrid document along with examples of hybrid clinic notes for three types of genetic counseling specialties is included in this document.

Analysis of pharmacy student communication self-evaluation skills during standardized patient encounters

IntroductionThe objective of this study was to evaluate pharmacy students' communication self-evaluation skills by comparing student self-evaluations with those completed by course graders and standardized patients (SP). MethodsAs part of a required communications course, third-year pharmacy students completed a medication counseling encounter with a SP during a midpoint encounter and final assessment. Students' communication skills were evaluated by course graders and SPs. Students used the same assessment rubric to also complete self-evaluations immediately after each event and after reviewing a recording of their midpoint encounter. Agreement among student, SP, and course grader ratings on individual items were examined using the kappa statistic. ResultsA total of 206 students completed the midpoint encounter, and 208 completed the final assessment. Agreement between students' and SPs' evaluations was high during both the midpoint and final encounters, with >90% agreement on 14 out of 17 items at the midpoint encounter and 16 out of 17 during the final assessment. There were diffiences in scoring for the use of verbal distractors/fillers, with SPs' evaluations showing more favorable scores when differences existed [at midpoint 69 (33.7%) SP vs. 7 (3.4%) student; at final 31 (15%) SP vs. 3 (1.5%) student]. Agreement improved from the midpoint to final assessment (62.9% vs. 83.7%, respectively). ConclusionsSelf-evaluation of communication skills may be an acceptable alternative to faculty or SP evaluations, when appropriate for the purpose of the activity, based on the high agreement observed among communication skills evaluations completed by students, course graders, and SPs.

Listing the whys and listening to the why nots

It's been recommended for decades that patient education encounters contain specific information, including drug onset of action, administration route, adverse effects, storage, and many more. These requirements, along with components of a drug utilization review and written documentation, are detailed in the Omnibus Budget Reconciliation Act of 1990 (OBRA ‘90) and have been widely adopted in pharmacies nationwide. Explaining this required information to patients is absolutely vital. However, if we focus on that alone, we risk minimizing an essential piece of the patient counseling puzzle: the process of education. Descriptions of the patient education process paint a more interactive picture with broader strokes that include establishing a caring relationship; assessing patients’ attitudes toward their health problems; and exploring cultural identity and how it impacts patient care. I would argue that by dropping these crucial components from many of our patient interactions, we risk missing out on a much bigger picture. In this month's cover story (p. 26) on structural racism, Anne Lin, PharmD, of the Notre Dame of Maryland School of Pharmacy describes a counseling encounter with a vaccine-hesitant coworker that was ultimately successful. She recalls explaining the reasons the vaccine was important and did not dismiss her patient's concerns. In other words, she listed the whys and listened to the why nots. When we neglect exploring deeper issues such as culture, barriers to care, and bias with our patients and within ourselves, we contribute to structural racism. In this issue, you'll get details on recent drug approvals (p. 14), intermittent use of intranasal corticosteroids for allergic rhinitis (p. 21), and strategies to address unmet mental health needs in your patients (p. 19). Catch up on your CPE and prepare for the upcoming influenza season with our comprehensive 2021 immunization update (p. 52). As human beings, each of us is susceptible to overlooking a patient's or colleague's perspective, their cultural identity, and barriers to care. As pharmacists, we have a responsibility to acknowledge and recognize these perspectives, our own internal biases, and implicit biases that patients face in the health care system. As a profession, we can strive to be better listeners to what our patients say and what they don’t say, and address our own internal preconceptions about culture, socioeconomic status, and race to affect change to structural racism. It starts with me, it starts with you, but ultimately it will take all of us working together.

Trends in coverage and reimbursement for reproductive genetic counseling in New Jersey by multiple payers from 2010 to 2018

Lack of consistent insurance coverage for genetic counseling services billed under Current Procedural Terminology (CPT) code 96040 creates a barrier for access to this service. This retrospective study examined coverage and reimbursement for reproductive genetic counseling encounters billed under CPT code 96040 as a professional fee over an eight-year period at Rutgers Robert Wood Johnson Medical School, a regional perinatal center in New Jersey, a state requiring licensure. Descriptive statistics were tabulated to assess the disparity between Medicare/Medicaid, Managed Care Medicaid, and commercial insurance payers, including how often encounters were covered and if reimbursed, at what percentage of the amount billed. A comparison of individual plan types (Health Maintenance Organization, Point of Service, and Preferred Provider Organization) was carried out. Overall trends in reimbursement were assessed across payers. The study found 61% of 60-min encounters billed to Medicare/Medicaid, Managed Care Medicaid, and commercial insurance payers received coverage. Of all covered 60-min encounters billed to Managed Care Medicaid and commercial insurance payers, an average of 36% of the amount billed was reimbursed. Medicare/Medicaid encounters were never reimbursed. Commercial insurance covered 65% of encounters billed but this varied between payers. Across all payers, an overall downward trend of reimbursement was demonstrated over the eight-year period. Lack of consistent service coverage creates a barrier and patients cannot universally access genetic counseling services. Steps to improve coverage need to include passing of legislation, notably the next bill to replace the former H.R. 3235, 'Access to Genetic Counselor Services Act of 2019' and provisions within third-party payers that allow for credentialing of genetic counseling providers.