Directive Counseling Research Articles

ETHICS OF TERMINATION OF PREGNANCY (TOP) IN MYASTHENIA GRAVIS: A CASE REPORT

Introduction: Myasthenia gravis (MG), an autoimmune disorder characterised by muscle weakness caused by impairment of the acetylcholine receptors at the neuromuscular junction as a result of autoantibodies acting against the ACh receptors, is twice as common in women, occurring in the second and third decades. Successful pregnancy outcomes are possible with patient compliance to medication and care by a multidisciplinary team.Objective: The article demonstrates the ethical dilemma doctors face when dealing with termination of pregnancy in myasthenia gravis in pregnancy.Discussion: During pregnancy, MG exacerbates in one third of patients during the first trimester, and tends to improve during the second and third trimesters, with most women achieving normal delivery. The authors put up a case where decision for termination of pregnancy (TOP) could have been avoided through application of an ethical decision making framework. The patient could have decided otherwise if a clear alternative line of management had been offered. Fully informed consent is essential preserving was not given and patient autonomy in such complex decisions. The emotive effects on the patient that biomedical imaging like showing a normal and active foetus through ultrasonography also needs to be considered.Analysis: A possible ethical framework using some of the principles of ethical decision-making, under the headings of i). Clear justification according to the norms and values of the individual, law and society for the intervention ii). Patient autonomy iii). Incongruence between parents in the abortion decision iv). The foetus as a person v). Directive counselling vi). Principle-based ethics, and, vii). Case-based ethics and case-based reasoning could be applied when confronted with the issue of termination of pregnancy in MG. While principle-based ethics is a useful starting point, care-based ethics also has a place in decisions on TOP.

Donor Conception Disclosure: Directive or Non-Directive Counselling?

It is widely agreed among health professionals that couples using donor insemination should be offered counselling on the topic of donor conception disclosure. However, it is clear from the literature that there has long been a lack of agreement about which counselling approach should be used in this case: a directive or a non-directive approach. In this paper we investigate which approach is ethically justifiable by balancing the two underlying principles of autonomy (non-directive approach) and beneficence (directive approach). To overrule one principle in favour of another, six conditions should be fulfilled. We analyse the arguments in favour of the beneficence principle, and consequently, a directive approach. This analysis shows that two conditions are not met; the principle of autonomy should not be overridden. Therefore, at this moment, a directive counselling approach on donor conception disclosure cannot be ethically justified.

Tinnitus Retraining Therapy

According to the Jastreboff’s neurophysiological model of tinnitus, if negative associations are attached to the tinnitus signal, tinnitus is perceived to be a threat or a danger and it activates the autonomic nervous and limbic systems. Consequently patient’s awareness of tinnitus is heightened and so patient perceives it to be louder and more persistent. Jastreboff and Hazell started tinnitus retraining therapy (TRT) based on the neurophysiological model of tinnitus. The purpose of TRT is blocking tinnitus from activating the sympathetic nervous and limbic systems (habituation of reaction) and from reaching the cerebral cortex (habituation of perception). TRT is composed of two components directive counseling that tries to reclassify tinnitus into the meaningless stimuli and sound therapy that decreases the relative strength of the tinnitus signal. Physicians try to put patient’s tinnitus into the territory of meaningless stimuli through retraining the brain (habituation of reaction). Because the brain habituates all unimportant stimuli, if habituation of reaction is fully achieved, habituation of perception will follow automatically. In most clinical results, clinical success rates of TRT approach or exceed 80% improvement. Early improvement can be achieved during the first few months, followed by additional progressive improvement. It should be recommended that the patient continue treatment at least 18 months.

ANALISIS KELEMBAGAAN GAPOKTAN DALAM KEGIATAN LEMBAGA DISTRIBUSI PANGAN MASYARAKAT (LDPM) DI KABUPATEN GROBOGAN

<p><em>This research aims to explain in detail about the condition of Gapoktan institutional through activities of</em><em> </em><em>Reinforcement of Society Food’s Distributive Institution</em><em> (</em><em>Reinforcement</em><em>-LDPM) </em><em>at</em><em> </em><em>the Regency of </em><em>Grobogan </em><em>considered from </em><em>superstru</em><em>c</em><em>tur</em><em> aspect</em><em>, </em><em>community </em><em>profil</em><em>es</em><em> </em><em>of farmers the member of Gapoktan</em><em>, </em><em>and</em><em> organizational profile</em><em> aspect of the</em><em> Gapoktan. </em><em>Qualitative method and descriptive approach were used in this research</em><em>. </em><em>The sampling was </em><em>snowball sampling</em><em> technique</em><em>. </em><em>The technique of data collection used visceral interview, observation, and record-keeping. The tryout of data validity used </em><em>triangula</em><em>tion</em><em> </em><em>source</em><em> </em><em>and </em><em>triangula</em><em>tion</em><em> met</em><em>hod</em><em>, </em><em>whereas</em><em> </em><em>the data analysis used three</em><em> </em><em>main components, i.e.</em><em> (1) </em><em>data reduction,</em><em> (2) data</em><em> display,</em><em> </em><em>and</em><em> (3) </em><em>drawing conclusion and verification.</em><em> B</em><em>ased on the research result, it can be concluded that analysis of Gapoktan institutional considered from </em><em>superstru</em><em>c</em><em>tur</em><em>e aspects</em><em> </em><em>including government policy which influenced </em><em>Gapoktan</em><em> institutional</em><em>. </em><em>Both the federal government and local government of </em><em>Grobogan</em><em> Regency have issued some policies that support the reinforcement activities of Society Food’s Distributive Institution</em><em> (LDPM)</em><em>, but</em><em> </em><em>the government policy about Bulog standardization was considered that it was too difficult for </em><em>Gapoktan </em><em>institutional</em><em>. </em><em>Considered from community profile, the development of </em><em>Gapoktan</em><em> institutional</em><em> </em><em>has transpired well enough because of having sufficient </em><em>asset, </em><em>collective action in both of routine meeting and directive counseling</em><em>, </em><em>drawing conclusion by the chief of </em><em>Gapoktan </em><em>through discussion and coordination focus</em><em>, </em><em>whereas the relationship between </em><em>Gapoktan </em><em>institutional with the other Gapoktan has transpired well</em><em>. </em><em>Considered from its institutional profile</em><em>, </em><em>the Gapoktan still had constraints or problem. Looking to its organization system, the structure of labor units</em><em> </em><em>of the reinforcement activities of Society Food’s Distributive Institution </em><em>(LDPM) </em><em>had not been organized well</em><em>. </em><em>The members prefer to profitable jobs than the voluntary Gapoktan. Outsides, the institutional management and resource allocation had not well complied.</em></p>

A painful inheritance-patient perspectives on living with polycystic kidney disease: thematic synthesis of qualitative research.

Autosomal dominant polycystic kidney disease (ADPKD) is a life-threatening genetic disorder and has multiple complications including, infection, pain, intracranial aneurysm and kidney failure leading to significantly impaired quality of life and reduced survival. These outcomes are well described, but patient perspectives and experiences of living with ADPKD are under-recognized. MEDLINE, Embase, PsycINFO and CINAHL were searched to August 2014. Studies were analyzed using thematic synthesis. From 21 studies (n = 247), we derived five themes: unvalidated pain (medical trivialization, inadequacy of pain management); persisting uncertainties and ambiguities (lacking diagnostic clarity, disempowerment in self-care, unpredictable daily disruptions, inability to plan ahead, financial discrimination); genetic guilt and resentment (blaming parents, self-blame, constant burden of guilt); precariousness in pursuing parenthood (prognostic uncertainty, owning the decision, needing directive counselling); and defining parental responsibility for genetic testing and disclosure (preserving normality, doubting necessity of genetic testing, respecting the child's autonomy and hope in future technologies, facilitating preparedness). The erratic onset of pain contributes to the substantial unpredictability of daily living and prevents patients from establishing long-term life goals. Decisions about family planning, genetic testing of children and disclosure involves making profoundly difficult judgments about ethical parental responsibility. Patient engagement in pain management, strategies for self-care, counselling to reduce the burden of 'genetic guilt' and specific family planning decision support tools may be priorities for care to improve patient-centred outcomes in ADPKD.

The Professional Responsibility Model of Obstetric Ethics in Clinical Practice

This paper provides an overview of ethical issues in obstetrics and gynecology. We first define two basic ethical principles, beneficence and respect for autonomy. We first apply these principles to gynecologic practice, emphasizing the role of informed consent. We then apply these principles to obstetric practice, utilizing the concept of the fetus as a patient and identifying its clinical implications for directive versus non-directive counseling for fetal benefit.

Putting Research into Practice for Autism Spectrum Disorder

Putting Research into Practice for Autism Spectrum Disorder

Challenges faced by health-care providers offering infant-feeding counseling to HIV-positive women in sub-Saharan Africa: a review of current research

Exclusive breastfeeding (EBF) has been identified as the optimal nutrition and critical behavior in attaining human immunodeficiency virus (HIV)-free infant survival in resource-limited settings. Health-care providers (HCPs) in clinic- and community-settings throughout sub-Saharan Africa (sSA) provide infant-feeding counseling. However, rates of EBF at 6 months of age are suboptimal. HCPs are uniquely positioned to educate HIV-positive mothers and provide support by addressing known barriers to EBF. However, limited evidence exists on the experiences faced by HCPs in providing counseling on infant feeding to HIV-positive women. Our objective is to describe experiences faced by HCPs when delivering infant-feeding counseling in the context of HIV in program settings in sSA. We searched a range of electronic databases, including PubMed, CINAHL, and PsycINFO from January 1990 to February 2013, in addition to hand-searching, cross-reference searching, and personal communications. The search was limited to publications in English. Empirical studies of HCP experiences providing infant-feeding counseling in the prevention of mother-to-child transmission (PMTCT) of HIV programs in sSA were selected. We identified 10 peer-reviewed articles reporting HCP challenges in infant-feeding counseling that met inclusion criteria. Articles included qualitative, cross-sectional and mixed-method studies, and cumulatively reported 31 challenges faced by HCPs. Among the challenges identified, the most commonly reported were personal beliefs held by the HCPs toward infant feeding in the context of HIV, contradictory messages, staff workload, directive counseling styles, and a lack of practical strategies to offer mothers, often leading to improvised counseling approaches. Counseling strategies need to be developed that are relevant, meaningful, and responsive to the needs of both HCPs and mothers.

Assessing Peer Advisor Intervention Fidelity Using Video Skits in a Peer Support Implementation Trial

In community-based interventions involving lay health workers, or "community health workers," peer-client interactions are not typically observed by investigators, creating challenges in assessing intervention fidelity. In the context of a community-based randomized controlled trial of the effectiveness of peer support on diabetes outcomes of people with diabetes in rural Alabama, a region characterized by poverty and low literacy, we developed a video assessment tool that assessed participant perceptions of peer-client interactions. The video assessment consisted of four short skits on areas of emphasis during peer training: directive versus nondirective counseling style and setting a specific versus a more general goal. The video tool was evaluated for association with questionnaire-derived measures of counseling style and goal setting among 102 participants. For counseling style, 44% of participants reported that their peer advisor was most similar to the nondirective skit. For goal setting, 42% reported that their peer advisor was most similar to the specific goal skit. There was no statistically significant relationship between skit selection and questionnaire-derived measures. The video assessment was feasible, but results suggest that video and questionnaire assessments in this population yield different results. Further validation to better understand the differences between questionnaire reports and video assessment is warranted.

一側性音響刺激を用いたTRT単独療法の2年以上の長期効果

We have previously reported on the effects of tinnitus retraining therapy (TRT) involving monaural noise generators (NGs) up to 24 months after the start of treatment (Eur Arch Otorhinolaryngol. 2013 Feb; 270(2) : 443-8.) but very few reports exist about the long-term effects of TRT for periods of over 2 years. The aim of this study was to report the effects of TRT involving monaural NGs more than 24 months after the start of treatment. Thirty-three patients with chronic tinnitus were included in this study. All received directive counseling and monaural NGs without any other combination treatment. Effects were evaluated with the Tinnitus Handicap Inventory (THI) at their final visits to our clinic (average 31 months after the start of treatment). The average THI scores significantly improved from 55.3 +/- 19.7 at baseline to 33.5 +/- 23.3 at their final visits. Seventeen patients (52%) improved by more than 20 points from the baseline. Eleven patients who were treated with TRT for more than 3 years were individually observed in a detailed manner. Some of them experienced aggravation of their symptoms after 2 years' successful treatments. This study suggests that, although TRT seems effective more than 2 years after the start of treatment, the clinical course of each patient can vary and we need to follow them periodically depending on their situations and symptoms.

Capsule Commentary on Putman et al., Directive Counsel and Morally Controversial Medical Decision-Making: Findings from Two National Surveys of Primary Care Physicians

Putman et al.1 utilized two independent cross-sectional surveys to investigate whether primary care providers (PCPs) are less likely to endorse directive counsel for “morally controversial” medical decisions compared to typical ones. The first survey asked abstractly about directive counseling, and found that physicians were less likely (35 % vs. 65 %) to endorse directive counseling for morally controversial than typical decisions. The second survey included a clinical vignette of a patient requesting palliative sedation; in this case, 41 % of providers endorsed directive counsel, while 51 % endorsed avoiding influencing the patient’s decision. Physicians were more likely to endorse directive counseling if the physician attended religious services, considered religion to be fairly or mostly important, or were less theologically pluralistic. It is interesting to note that the gap narrowed from the abstract question about morally controversial decision to a more concrete clinical vignette. While limited by responder bias,2 the weak association between self-report and provider behavior and the cross-sectional study design, this study suggests that physician beliefs affect their opinions about directive counsel for morally controversial decisions. It highlights the important tension between being directive and nondirective with respect to clinical decision-making. Physicians are not passive bystanders; they bring their own beliefs and biases to the conversation. Though this investigation examines directive counsel surrounding the specific scenario of palliative sedation, previous studies have found that physicians are more likely to reject directive counsel in similar morally controversial areas, such as sexual and reproductive health.3 For medical educators, these findings highlight how world views held by learners at all levels may impact the art of respectfully counseling patients regarding both typical and morally controversial medical decisions. If this hesitancy translates to providing less information, this could be important; shared decision-making is complex, and one of our primary duties is support and enhance patients’ abilities to make autonomous decisions about their care.4 The line between directive counseling and nondirective counseling can be difficult to delineate. While it is a truism that we should not impose our own beliefs or value systems on patient decision-making, if we hesitate to provide adequate counseling we also fail as providers. Further research is needed.

ANALISIS GENDER PADA MANAJEMEN USAHA SEKTOR MIKRO (STUDI KASUS INDUSTRI PEMBUATAN GULA KELAPA DI KABUPATEN SLEMAN)

This study purposed to describe gender profile of the micro enterprise management from four aspects: productive activities, non productive activities, access and control, business effect and benefit. It also aimed to formulate strengthening strategy based on gender perspective. The research was performed in Sleman regency with 25 micro enterprises in brown sugar as research samples. Simple random sampling was chosen in the process of selecting lata and Harvard Analytical Framework was adopted to analysis it. The research discovered some findings. First, women have had dominant contribution in all activities, both in business management and in production process. Second, the profile of domestic activities such as cooking, shopping, maintaing household was majority organized by women. Third, women access and control over resources were higher than men. Fourth, the entire resoulrces and the production outcome were able to provide benefit for family members, particularly for women. Fifth, this industry was not only needed strengthening program in the term of technical assistance such as finance, marketing, and information but it also required spesific assistance programs to accomplish women gender practice. According to the research findings, it is essential to conduct training, directive counseling to socialize gender equality and equaly in micro industries. It is also vital to carry out women empowerment program to advance their productivity and welfare.

ETHICAL DIMENSIONS OF THE FETUS AS A PATIENT

Objective: To describe the ethical concept of the fetus as a patient and identify its implications for the deliberative practice of perinatal medicine.Methods: We describe secular medical ethics and its two fundamental principles, beneficence and respect for autonomy. We articulate the ethical concept of the fetus as a patient on the basis of the ethical principle of beneficence.Results: In the deliberative practice of perinatal medicine guided by the ethical concept of the fetus as a patient, the perinatologist should always identify and balance beneficence-based obligations to the fetal patient and beneficence-based and autonomy-based obligations to the pregnant patient. Directive counseling is appropriate when the fetus is a patient. Non-directive counseling is appropriate when the fetus is not a patient.Conclusion: Counseling pregnant women about the clinical management of their pregnancies should always identify and balance beneficence-based obligations to the fetal patient and beneficence-based and autonomy-based obligations to the pregnant patient.

A qualitative interview study exploring pregnant women’s and health professionals’ attitudes to external cephalic version

BackgroundWomen who have a breech presentation at term have to decide whether to attempt external cephalic version (ECV) and how they want to give birth if the baby remains breech, either by planned caesarean section (CS) or vaginal breech birth. The aim of this study was to explore the attitudes of women with a breech presentation and health professionals who manage breech presentation to ECV.MethodsWe carried out semi-structured interviews with pregnant women with a breech presentation (n=11) and health professionals who manage breech presentation (n=11) recruited from two hospitals in North East England. We used purposive sampling to include women who chose ECV and women who chose planned CS. We analysed data using thematic analysis, comparing between individuals and seeking out disconfirming cases.ResultsFour main themes emerged from the data collected during interviews with pregnant women with a breech presentation: ECV as a means of enabling natural birth; concerns about ECV; lay and professional accounts of ECV; and breech presentation as a means of choosing planned CS. Some women’s attitudes to ECV were affected by their preferences for how to give birth. Other women chose CS because ECV was not acceptable to them. Two main themes emerged from the interview data about health professionals’ attitudes towards ECV: directive counselling and attitudes towards lay beliefs about ECV and breech presentation.ConclusionsWomen had a range of attitudes to ECV informed by their preferences for how to give birth; the acceptability of ECV to them; and lay accounts of ECV, which were frequently negative. Most professionals described having a preference for ECV and reported directively counselling women to choose it. Some professionals were dismissive of lay beliefs about ECV. Some key challenges for shared decision making about breech presentation were identified: health professionals counselling women directively about ECV and the differences between evidence-based information about ECV and lay beliefs. To address these challenges a number of approaches will be required.

Rationale for the tinnitus retraining therapy trial.

The Tinnitus Retraining Therapy Trial (TRTT) is a National Institutes of Health-sponsored, multi-centered, placebo-controlled, randomized trial evaluating the efficacy of tinnitus retraining therapy (TRT) and its component parts, directive counseling and sound therapy, as treatments for subjective debilitating tinnitus in the military. The TRTT will enroll 228 individuals at an allocation ratio of 1:1:1 to: (1) directive counseling and sound therapy using conventional sound generators; (2) directive counseling and placebo sound generators; or (3) standard of care as administered in the military. Study centers include a Study Chair's Office, a Data Coordinating Center, and six Military Clinical Centers with treatment and data collection standardized across all clinics. The primary outcome is change in Tinnitus Questionnaire (TQ) score assessed longitudinally at 3, 6, 12, and 18-month follow-up visits. Secondary outcomes include: Change in TQ sub-scales, Tinnitus Handicap Inventory, Tinnitus Functional Index, and TRT interview visual analog scale; audiometric and psychoacoustic measures; and change in quality of life. The TRTT will evaluate TRT efficacy by comparing TRT (directive counseling and conventional sound generators) with standard of care; directive counseling by comparing directive counseling plus placebo sound generators versus standard of care; and sound therapy by comparing conventional versus placebo sound generators. We hypothesize that full TRT will be more efficacious than standard of care, directive counseling and placebo sound generators more efficacious than standard of care, and conventional more efficacious than placebo sound generators in habituating the tinnitus awareness, annoyance, and impact on the study participant's life.

The Professional Responsibility Model of Ethics in Perinatal Medicine

Objective: To describe the professional responsibility model of ethics in perinatal medicine, based on the fetus and pregnant woman as patients, to guide the deliberative practice of perinatal medicine. Methods: We describe secular medical ethics and its two fundamental principles, beneficence and respect for autonomy. We articulate the ethical concept of the fetus as a patient on the basis of the ethical principle of beneficence. Results: In the deliberative practice of perinatal medicine guided by the professional responsibility model, the perinatologist should always identify and balance beneficence-based obligations to the fetal patient and beneficence-based and autonomy-based obligations to the pregnant patient. Directive counseling is appropriate when the fetus is a patient. Non-directive counseling is appropriate when the fetus is not a patient. Conclusion: Counseling pregnant women about the clinical management of their pregnancies should always identify and balance beneficence-based obligations to the fetal patient and beneficence-based and autonomy-based obligations to the pregnant patient.

Small-Group Counseling in a Modified Tinnitus Retraining Therapy for Chronic Tinnitus

ObjectivesThe authors have treated chronic tinnitus patients using a combination of a simplified tinnitus retraining therapy (TRT) and medications, which we called modified TRT. In this clinical setting, we have attempted small-group counseling to find a time-effective equivalent of individual counseling. The aim of the present study was to evaluate the effectiveness of small-group counseling by comparing the treatment outcomes between individual and small-group counseling.MethodsThe patients who had distressing chronic tinnitus with normal hearing or mild hearing loss were included. The subjects were placed into the small-group (group 1:4) or the individual (group 1:1) counseling group, and underwent a modified TRT composed of a single session of directive counseling and ambient sound stimulation. In addition, alprazolam (0.25 mg) and ginkgo biloba extract (80 mg) were administered orally to the subjects for 3 months. The 3- and 6- month outcomes were assessed using the follow-up rates and tinnitus severity scores: awareness, tinnitus handicap inventory (THI), loudness, annoyance, and effect on life. The treatment responses were classified as improvement, no changes, and worsening.Results Of the total 149 patients (77 in group 1:1; 72 in group 1:4), 104 patients completed the protocol at 3 months, and 55 patients at 6 months. The follow-up rates were similar in both groups. Over the period of 6 months, all scores declined significantly except the loudness score at 3 months in both groups. Treatment responses showed no between-group differences. The success rate based on THI was 70% in group 1:1, and 64% in group 1:4 at 6 months.ConclusionThe small-group counseling of our modified TRT was comparable to the individual counseling for tinnitus relief. We suggest that this protocol can be implemented effectively in any crowded otolaryngology clinics.

"I didn't know it existed before you called": protestant clergy experience, education and perceptions regarding genetics.

Despite the intrinsic role religious/spiritual (hereafter, R/S) beliefs have in patient clinical decision-making and crisis coping, there is little research exploring the relationship that exists between clergy (professionals who provide R/S counsel and guidance) and genetic counseling patients. This qualitative, exploratory study was designed to explore Protestant clergy (N = 8) perceptions of and experience with genetics-related issues. Data analysis revealed that a wide range of R/S perceptions regarding genetics-related issues exist within Protestantism, Protestant clergy have a basic understanding of genetic testing and conditions, and while directive counseling is inherent to Protestant clergy counseling, there appears to exist two opposing styles: unbiased and biased. Based on this information, there are two main implications for genetic counseling clinical practice. First, R/S assessments need to be increasingly implemented into genetic counseling sessions, so that the psychosocial needs of patients with specific R/S beliefs can be identified and addressed. An increase in R/S assessments may be accomplished by increased exposure in genetic counselor training, continuing education opportunities, and by establishing relationships with board-certified, professional chaplains. Second, genetic counselors can influence the genetic education and experience of clergy by raising awareness within their own R/S assemblies. Doing so can also serve to further educate genetic counselors in the R/S beliefs of their own traditions, thus increasing sensitivity, empathy and the quality of care provided.

Ethical challenges in the management of multiple pregnancies: the professional responsibility model of perinatal ethics

Abstract Ethics is an essential component for the responsible clinical management of multiple gestation and decision-making about such pregnancies with pregnant women. The ethical concept of the fetus as a patient is presented as the basis for identifying a professionally responsible approach to selective termination, twin-to-twin transfusion syndrome, and to discordant beneficence-based obligations that exist when one or more fetuses are adversely affected by a fetal anomaly or complication of pregnancy. The roles for directive counseling, i.e., making evidence-based recommendations, and for non-directive counseling, i.e., offering evidence-based alternatives but making no recommendations, are described. The professional responsibility model of perinatal ethics creates a practical framework to guide the clinical judgment of perinatologists and the informed process about the clinical management of multiple pregnancies.

Psychosocial aspects of preconception consultation in primary care: lessons from our experience in clinical genetics

To date, little is known about the psychosocial aspects of preconception consultation (PCC) in primary care. PCC in primary care is appropriate for couples and individuals with a reproductive wish. In PCC, non-genetic and genetic risk factors may be identified. Focusing on non-genetic and genetic risk factors in PCC requires the use of different counselling strategies and tools in optimizing the outcome of pregnancy. Addressing lifestyle alterations requires directive counselling, whereas addressing increased genetic risk and its subsequent reproductive options requires non-directiveness. When an increased genetic risk is detected, couples should be informed about their possibilities for not passing on a disease allele. Depending upon the various modes of inheritance and reproductive options, couples may face a variety of psychosocial challenges. This paper aims to provide insights into the psychosocial impact of the genetic aspects of PCC by drawing upon literature and clinical experience in the Clinical Genetics department. Furthermore, this paper provides consideration for future developments regarding preconception genetic screening.