Moreover, decisions made before counseling largely determined reproduction after counseling.
A study of patients' expectations of genetic counseling revealed that the majority had their expectations fulfilled, especially with perceived personal control.1052 When patients' expectations for reassurance and advice were met, they were subsequently less concerned and had less anxiety when compared with such expectations that were not fulfilled, similar to the Netherlands report.1043
The limited efficacy of genetic counseling revealed in the study by Sorenson et al.1049 reflects the consequences of multiple factors, not the least of which were a poor lay understanding of science.1036 Efficacy, of course, is not solely related to counselee satisfaction. Efforts to educate the public about the importance of genetics in their personal lives have been made by one of us in a series of books (one translated into nine languages) over 50 years.184, 331, 335, 337, 338, 1053 In addition to public education and its concomitant effect of educating physicians generally, formal specialist certification in the United States, Canada, the United Kingdom, and elsewhere, acceptance of clinical genetics as a specialty, and degree programs for genetic counselors certified by the National Board of Genetic Counselors, has undoubtedly improved the efficacy of genetic counseling. There remains, however, a pressing need to better educate practicing physicians about the “new genetics”184, 185, 199, 1054, 1055 in this, the golden era of human genetics.
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