Constructing rapport in televideo genetic counseling

Abstract

The typical strategies that generic counselors use to establish rapport with patients in face-to-face situations are undermined by the used of televideo. Leaning forward to show concern and support, establishing direct eye contact to convey interest, respect, and receptiveness, and being able to reach out and touch someone when they display signs of anxiousness or fear: these things just do not “work” in a televideo counseling session. In a series of pretest using PC computers networked to simulate an Internet-like connection, video cameras, and headsets, we have developed a set of strategies for establishing a physical and social context conducive to the development of rapport in televideo counseling sessions. The physical context of the session may be optimized by altering camera placement to approximate direct eye contact and to permit viewing of both facial features and hand gestures; and by orienting the patient to the unique features of the televideo equipment (such as cursor movements, the short audio time delay, positioning of visuals aids, and so on). The social context of the televideo consultation may be made more conducive to the development of rapport by establishing patient control over the situation (having them adjust the camera for better viewing, encouraging the patient to use non-verbal cues to interrupt the counselor, and having the counselors practice ways of repairing communication break-downs that occur from “talking over” one another). These general strategies may be supplemented by having the counselors practice the kinds of rapport-building techniques that seem to work in both traditional face-to-face and televideo counseling sessions: using non-verbal cues(smiling, nodding), verbally assessing patients understanding and perception of risks, verbally expressing empathy, etc. We are utilizing this protocol in an on-going prospective trial regarding the use of televideo genetic counseling in an advanced maternal age population.