OUTCOMES AND PROCESS IN GENETIC-COUNSELING

Although it may be simple to evaluate some elements of clinical geneti cs, it is difficult to evaluate genetic counselling. We review previou s studies of the outcomes of genetic counselling; although the methods used may be valid in research studies, there are practical and ethica l difficulties in applying them to the measurement of clinical effecti veness in standard practice. No simple measures of outcomes would be s uitable. Research evidence will be helpful in deciding what services i t is appropriate to offer, and the quality of a service can then be as sured by assessing the quality of the clinical process in three ways: 1) adherence to agreed protocols and standards of care; 2) peer review and audit of clinical activity; and 3) ongoing review of the satisfac tion of clients and referring physicians with the service. The assessm ent of client satisfaction will need to be a sophisticated form of ret rospective satisfaction with the service provided, and such a scheme h as yet to be fully developed.