As in other areas of medical practice, relatives accompany patients to genetic consultations. However, unlike in other areas, the consultations may be relevant to the relatives’ health because they may be at risk of developing the same genetic condition as the patient. The presence of relatives in genetic consultation may affect the decision‐making process and it raises questions about the perception of patient autonomy and the way it is practiced in genetics. However, these issues have not been examined in previous (...) empirical studies. This article aims to fill this gap by reporting findings from a qualitative study with clinicians working in the area of inherited breast cancer. The findings indicate that family presence has an impact on the patient's decisions to undergo genetic testing and preventative operations when she is diagnosed as a carrier. The findings further indicate that, unlike in other areas of medical practice, blood relatives who are present in consultations are perceived by clinicians as patients or potential patients, and this in turn increases their involvement in discussions in the consultation room. Finally, the findings indicate that in genetics, a relational approach to autonomy is applied. Decisions are made in a social context, where the relatives’ views are heard and taken into account. The findings suggest that the conventional bioethical approach to autonomy, which perceives the decision‐making unit as comprising a clinician and an individual patient, is challenged in genetics. The findings thus suggest that bioethicists, lawyers and policy‐makers should consider whether this individualistic approach is still valid and applicable. (shrink)

Leading research projects are evidence of the growing public interest in genetic diagnosis and treatment. In this context, disclosure of genetic information to relatives has become a prominent issue. However, this involves patient confidentiality, which is grounded in law and conflicts with disclosure to relatives. When conducting a legal and bioethical discussion in this context, it is first necessary to examine how clinicians perceive the role of law in their practice and how they interpret it. A qualitative study was therefore (...) conducted among clinicians in Israel. The findings indicate that the clinicians’ approach is more relational than that of the law, in view of their pro-active steps to ensure that familial information reaches the relatives when the patient is reluctant to convey this information themselves. In light of these findings the authors argue that the law can resolve situations of explicit and implicit refusal to inform relatives. (shrink)

BARNOY S, OFRA L and BAR‐TAL Y. Nursing Inquiry 2012; 19: 128–133 [Epub ahead of print]What makes patients perceive their health care worker as an epistemic authority?Health care workers’ (HCW) perceived epistemic authority (EA) may have an effect on patient decision‐making and compliance. The present study investigated the hypotheses that higher EA is attributed to staff perceived to be experts; to physicians rather than nurses; to HCWs who recommend taking a test more than to the ones who make no recommendation. (...) The study was based on a factorial 2 × 2 × 2 within‐between subjects design. The questionnaire presented four scenarios, each illustrating a HCW presenting information on a devastating genetic disease. The three variables manipulated were: HCW expertise, HCW role, and making a recommendation or not. After each scenario participants were asked questions about the EA they attributed to the HCW in the scenario. The results show main effects for perceived expertise and recommendation/no recommendation on the level of EA attributed. Expert nurses were judged to have the same high EA as expert physicians. But expert physicians who recommended taking a test were judged as having significantly higher EA than expert physicians who made no recommendation. Among nurses who made no recommendation, expert nurses were evaluated as having significantly higher EA than novices. Since expert nurses were perceived to have equal expertise as expert physicians, it follows that information given by both nurses and physicians can reduce patient uncertainty. (shrink)

Influenza is a major cause of morbidity and mortality. Although vaccination is an efficient means of prevention, low rates of vaccination are reported periodically. The study aimed to examine factors affecting acceptance of nurses' recommendations to take or avoid influenza vaccination. Study design was quasi‐experimental with a 2 × 2 between subjects design: two variables were manipulated and two were not. The research variables were expertise (of nurses and respondents), type of recommendation (to vaccinate or not) and respondents' a‐priori intention (...) to vaccinate. Data were collected from 374 respondents. The study was scenario based, differing in nurse expertise and type of recommendation. After each scenario, the respondents were requested to indicate their a‐priori intention to vaccinate and to complete questionnaires on epistemic authority (EA) attributed to the nurse, and of self‐epistemic authority (SEA). There is a general tendency to avoid vaccination. Intention to vaccinate correlated positively with nurse recommendations, respondent a‐priori intention and nurse expertise. A significant three‐way interaction between respondents' SEA, nurse recommendations and nurse expertise was found. The nurse's recommendation has the strongest effect when the nurse is an expert and the respondent perceives him/herself as having high self‐EA. The results highlight the importance of patients' sense of knowledge for assuring their co‐operation and compliance with medical recommendations. (shrink)

The debate continues about whether people have a duty to pass on the positive results of their genetic tests to relatives who are at risk from the same disease, and, should they refuse, whether physicians and genetic counselors then have the duty to do so. To date, the role and views of nurses in this debate have not been investigated. In our study, a sample of Israeli nurses, untrained in genetics, were asked for their theoretical opinions and what practical steps (...) they would take in the case of patients' refusal to disclose. The nurses were very sure that patients should inform their families but were equally sure that nurses must respect their decision to disclose or not. Few said they would take practical steps to disclose information if the patient objected. The authors believe that the most useful and appropriate role for nurses in this field is in working to bring about co-operation between patients and family members. (shrink)