Insights Into Working Alliance: Predictors of Patient-Perceived Bond With Genetic Counselors Among a Diverse, Multispecialty Sample.

The Reciprocal Engagement Model of genetic counseling practice centers the patient-provider relationship as an essential component of practice, but few quantitative studies have assessed what influences this relationship in actual genetic counseling practice. Our study explored which factors are most strongly associated with the patient-perceived bond subscale of the Working Alliance Inventory in a variety of genetic counseling sessions using a diverse patient sample across multiple clinical specialties. There were 416 participants (50.4% non-Hispanic white) seen by 41 genetic counselors (95.1% non-Hispanic white) in a variety of specialty clinics, session modalities, and session types (i.e., pre- vs. post-test) as part of Stage 1 of the GC-PRO study, which investigated how in-session processes affect patient-reported outcomes at two academic institutions and one telehealth company. Participants completed multiple validated scales measuring patient empowerment, satisfaction, decisional conflict, and other patient experience measures (e.g., working alliance and patient-centered communication). Using hierarchical linear regression modeling, predictors of the bond between participants and their genetic counselors were assessed. There were 6 significant predictors in the final model (R2 a = 0.45). Higher patient-reported bond scores were associated with younger participants, Black participants, more patient-centered communication, higher patient-perceived levels of autonomy support, higher post-session patient-reported empowerment, and higher session satisfaction levels. Patient autonomy and empowerment had the largest effects and thus may be the most efficient path toward improving bond, but further research is needed to determine causal directionality. Few demographic categories were associated with a diminished bond score, suggesting that patients were generally able to connect with their genetic counselor equally well, though Black patients' stronger bonds merits further exploration.