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ENQUIRE PROJECT DETAILS BY GENERAL PUBLIC |
| Project Details |
| Funding Scheme : | General Research Fund | |||||||||||||||||||||||||||||||||||||||||||||||||||
| Project Number : | 758211 | |||||||||||||||||||||||||||||||||||||||||||||||||||
| Project Title(English) : | A Discourse Analytic Study of Telegenetic counseling in Hong Kong | |||||||||||||||||||||||||||||||||||||||||||||||||||
| Project Title(Chinese) : | 電話遺傳輔導在香港─一個話語分析研究 | |||||||||||||||||||||||||||||||||||||||||||||||||||
| Principal Investigator(English) : | Dr Zayts, Olga A | |||||||||||||||||||||||||||||||||||||||||||||||||||
| Principal Investigator(Chinese) : | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Department : | School of English | |||||||||||||||||||||||||||||||||||||||||||||||||||
| Institution : | The University of Hong Kong | |||||||||||||||||||||||||||||||||||||||||||||||||||
| E-mail Address : | zayts@hku.hk | |||||||||||||||||||||||||||||||||||||||||||||||||||
| Tel : | 28592762 | |||||||||||||||||||||||||||||||||||||||||||||||||||
| Co - Investigator(s) : |
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| Panel : | Humanities, Social Sciences | |||||||||||||||||||||||||||||||||||||||||||||||||||
| Subject Area : | Social Sciences | |||||||||||||||||||||||||||||||||||||||||||||||||||
| Exercise Year : | 2011 / 12 | |||||||||||||||||||||||||||||||||||||||||||||||||||
| Fund Approved : | 608,918 | |||||||||||||||||||||||||||||||||||||||||||||||||||
| Project Status : | Completed | |||||||||||||||||||||||||||||||||||||||||||||||||||
| Completion Date : | 30-4-2014 | |||||||||||||||||||||||||||||||||||||||||||||||||||
| Project Objectives : |
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| Abstract as per original application (English/Chinese): |
In this project we aim to investigate telegenetic counseling communication in Hong Kong. Genetic counseling is a complex interactional activity in which counselors inform their clients at risk of a genetic disorder about that disorder and available testing, and facilitate the clients’ decisions of whether to pursue genetic testing or not (Sarangi, 2000). Telegenetic counseling falls under the telemedicine framework and refers to counseling mediated by distant technologies (e.g. telephone, internet).
The proposed project builds on the research team’s previous work on face-to-face genetic counseling in which a substantial need to investigate alternative ways of providing these services was noted. This need arises from an increasing demand for genetic counseling services and limited available workforce in Hong Kong and neighboring China. While telemedicine has been applied and researched widely in various healthcare settings, research on telegenetic counseling, in particular in Hong Kong context, has been scarce. In addition, the implications of telemedicine have been surrounded by some ambivalence: the advantages advocated in some studies have been shown to contain potential pitfalls in other studies. The ambivalence surrounding telemedicine points to its multifaceted nature and suggests the need for further studies.
In this project rather than focusing on the outcomes of telecounseling, we will employ a discourse analytic perspective to examine the actual processes of telecounseling and how these outcomes are negotiated by participants in interaction. In order to achieve that we will video-and audio-record interactions between genetic counselors and clients, and collect other data of interactions mediated by distant technologies. Our analysis will be supplemented by semi-structured interviews with participants that will provide useful background information. By using these diverse sources of data we will explore the complexities and challenges of telegenetic counseling and how they are mediated by participants of these encounters.
Our interdisciplinary team includes both “outsiders” (i.e. discourse analysts) and “insiders” (genetic counselors), and our research has a strong applied orientation. The findings of the project will be communicated to the professional community through a number of channels: presentations at research sites and professional conferences; and by running a workshop. The findings could also be used to develop training materials for genetic counselors. The project outcomes will also be of interest to academics working in a variety of fields as it will shed light on the complex phenomenon of telegenetic counseling and offer a methodological approach to analyzing it. 本項目從話語分析的角度，調查在香港的電話遺傳輔導。遺傳輔導是一項複雜的互動溝通：輔導員向潛在遺傳性疾病風險的客戶講解遺傳性疾病，和現行的測試方法，協助他們決定是否接受遺傳測試（Sarangi, 2000）。電話遺傳輔導從屬於電話醫療的框架，是指用遙距技術（如電話或互聯網）的方式提供輔導。 這項目是建基於研究小組在早前進行的面對面遺傳輔導時的發現。小組在輔導時發覺有迫切需要研究另一種方式來提供輔導服務。這是因為遺傳輔導服務的需求不斷上升，而且人手有限。儘管電話醫療已在不同的醫療領域中受到廣泛應用和研究，電話遺傳輔導(特別在香港)的研究非常短缺。電話醫療應用當中存有矛盾：一些研究顯示電話醫療能帶來功效，但另一些研究卻指出功效潛在隱患。圍繞著電話醫療的矛盾心態指向其多面性的本質，顯示有進一步研究的需要。這項目的重點不在於電話輔導的效果，而是集中在電話輔導的過程，參與者如何從互動的協商達致輔導的成效。為了實現此目的，我們將用視像和錄音， 記錄遺傳輔導員和客戶之間的的互動，並收集其他利用遙距技術作溝通的數據。我們會與參加者進行面試，作為輔助我們分析的工具，好使我們獲得有用的背景資料。我們的目標是探索電話輔導的複雜性和挑戰性、和其溝通的方法，最終克服輔導的缺點。我們將研究參與者採用的的策略，以提升溝通的質素，實致輔導的目標。 我們跨學科的團隊，既包括「外人」（即話語分析員），也包括「內人」（遺傳輔導員）。我們的研究以應用為本。項目的研究結果將透過研究網站、工作坊、專業研討會，在專業社群中發表。研究的結果也可以用於開發教材，培訓遺傳輔導員。這項目有助說明電話輔導的複雜現象，並提供以方法學的方式，分析這些數據，對其他領域的學者也有用途。 |
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| Realisation of objectives: | The project team has successfully achieved all of the objectives of the study. The database of genetic counselling consultations for G6PD deficiency (face-to-face and telephone) was created to be used for the purposes of research and training of genetic counselling professionals (Objective 6). The supplementary data corpus compiled during the project includes clients’ questionnaires and interviews with genetic counselling professionals. The team has examined the data corpus using established discourse analytic methodologies (Objective 1). The data analyses included identifying the main themes of these consultations (Objective 2); exploring their complexities/ challenges (Objective 3); and identifying discourse strategies that can contribute to enhancing communication (Objective 4). The results of the data analyses were summarized in the form of manuscripts published in prestigious journals and edited volumes (both linguistic and medical professional); several manuscripts are under review and in preparation at the time of the submission of the current report (see part C for further detail). The results of the project have also been disseminated at international interdisciplinary and professional conferences (see part C). The project team ran a workshop “Genetic Consultations / Counselling in South Asia” at the 10th Asia-Pacific conference on Human Genetics that brought together leading genetic professionals and communication scholars from 5 countries in South Asia (Hong Kong, Malaysia, the Philippines, Indonesia and Thailand) and the UK. The team also organized two large-scale and a number of smaller scale workshops for professionals in Hong Kong. The PhD student who was recruited to work on the project successfully completed and submitted her PhD thesis. The team also provided research experience to one undergraduate student. The PI established the Winter School on Health Communication, and during the project the team organized two Winter Schools (December 2012 and 2013). The School was specifically targeted at professional practitioners, healthcare educators, researchers and others engaged in the field of healthcare communication. Feedback from participants commended the applicability of communication knowledge to the professional practice. The Winter School incorporated some findings of the project. The findings of the project were also incorporated into teaching MMedSc in Genetic Counselling programme (HKU). The PI mentored undergraduate students and a PhD student who developed a leaflet for clients with G6PD deficiency. Focus group meetings with professionals and client representatives to validate the leaflets were organized. The leaflet has now been approved by the Department of Health (HK Government) for use in all public hospitals in Hong Kong. | |||||||||||||||||||||||||||||||||||||||||||||||||||
| Summary of objectives addressed: |
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| Research Outcome | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Major findings and research outcome: | While there is a substantial body of communication-oriented research on face-to-face genetic counselling, studies that have examined tele- (or distant) mode of counselling are scarce, particularly in the non-English dominant context such as Hong Kong. The project has made a considerable contribution to the existing body of research by investigating this mode of counselling in the designated context. The project has highlighted some important benefits of counselling using distant devices that can potentially have a major impact on the professional practice, particularly when genetic counselling services are increasingly used across various healthcare settings, and there is limited available professional workforce. The project has shown that unlike wide-spread beliefs that face-to-face counselling is more beneficial to clients, distant counselling presents a viable (and at times preferred) option. While in distant mode of communication professionals and clients lack non-verbal means of communication, these are compensated for by other discourse and rhetorical strategies (e.g. repetition) so that the goals of communication are successfully met. The project examined authentic data of audio- and video-recorded consultations and identified several major analytic themes of telegenetic counselling that include communicating risk and uncertainty; explanation- and advice-giving; decision-making; responsibility (parental and professional); reassurance (following receiving bad news/ diagnosis). The team also investigated the issues of professional roles and identities in the context of tele-medicine; and how genetic counselling in intercultural contexts differs from mono-cultural and mono-lingual genetic counselling (for specific outputs see the list of publications in Part C). By examining these analytic themes the team identified a range of linguistic (discourse and rhetorical) strategies that the participants of these tele-encounters employ to achieve their goals and to mediate potential challenges of communication. These findings have been incorporated into training activities that the team has organized during the running of the project and after its completion (workshops for professionals; the Winter School on Health Communication; MSc teaching). The findings have been reported in a number of publications in peer-reviewed linguistic and professional journals and prestigious edited volumes. The findings have also informed the development of client information resources (leaflet for clients with G6PD deficiency and their family/ carers). It is planned that the database of telegenetic counselling consultations that has been created during the project will be used for further research, teaching and training activities. Among project outputs are also a successful completion of a PhD thesis; provision of research experience for an undergraduate student. | |||||||||||||||||||||||||||||||||||||||||||||||||||
| Potential for further development of the research and the proposed course of action: |
There are several potential for further developments of the project after its completion. First, the team has submitted another application to RGC for funding to investigate risk communication and decision making in genetic counselling across the lifespan of an individual. This future project will bring together the data corpora that the team has collected in the previous projects (in addition to a newly collected data in a different genetic counselling setting) to formulate more generalizable strategies that can be used by professionals regardless of the specific genetic context they are working in. The PI and other team members will continue to work on publications based on the collected data. It is also expected that the data will be included in presentations at local and international events (e.g. training activities for professionals; professional and interdisciplinary conferences). The results of the study will also be further disseminated to the student and professional community through the PI’s involvement into the MMedSc teaching programme at the Li Ka Shing Faculty of Medicine (HKU). | |||||||||||||||||||||||||||||||||||||||||||||||||||
| Layman's Summary of Completion Report: | The project took a communication-oriented perspective to investigate genetic counselling provided by distance (via telephone). In genetic counselling professionals meet with clients at risk of or diagnosed with a genetic disorder and discuss that disorder, clients’ risks and available testing. While face-to-face counselling has been widely researched, the distant mode has not received much attention. In addition, until recently there has been little research on counselling in non-English dominant contexts such as Hong Kong. The project has shown that while in counselling by telephone the participants do not have access to non-verbal means of communication (e.g. gestures), they employ a range of linguistic/ communication strategies that help them meet the aims of these consultations. The project has identifies some major themes of tele-counselling, such as communicating risk and uncertainty; responsibility (professional and parental); explanation- and advice-giving; decision-making. It has investigated the issues of professional roles and responsibilities; and the specifics of counselling in the designated non-English dominant context. The projects findings have been disseminated at local and international events (for language scholars and professionals) and published in prestigious international journals and edited collections. The findings have also been incorporated into teaching and training activities for medical students and professionals. | |||||||||||||||||||||||||||||||||||||||||||||||||||
| Research Output | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Peer-reviewed journal publication(s) arising directly from this research project : (* denotes the corresponding author) |
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| Recognized international conference(s) in which paper(s) related to this research project was/were delivered : |
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| Other impact (e.g. award of patents or prizes, collaboration with other research institutions, technology transfer, etc.): |
The PI was awarded the Faculty Knowledge Exchange Award (Faculty of Arts, HKU, 2013) for the project ‘Language and Communication in Genetic Counselling Settings in Hong Kong and South Asia’ The team ran two workshops for professionals involved in the provision of genetic counseling services in Hong Kong. The details of the workshops are as follows: Workshop “Communication in Genetic Counselling: Telephone Mode of Communication”, 20 August 2012 (Clinical Genetic Services, HK). Workshop “Discourse Analysis of Healthcare Communication”, 23 December 2011 (Clinical Genetic Services, HK). The PI established the Winter School on Health Communication targeted at professional practitioners, healthcare educators, researchers and others engaged in the field of healthcare communication. Feedback from participants commended the applicability of communication knowledge to the professional practice. The Winter Schools in 2012 and 2013 incorporated some findings of the project. The PI ic chairing Communication, Medicine and Ethics (COMET) conference that will take place at the University of Hong Kong on 25-27 June 2015. As part of the conference programme, the PI and other team members are organizing a panel on genetic counselling communication in Hong Kong and South East Asia. The findings of the project were also incorporated into teaching MMedSc in Genetic Counselling programme (HKU). Dr. Zayts mentored a group of undergraduate students and a PhD student (Alice Ho) who worked on building a website for professionals and caretakers of clients with genetic disorders and developing a leaflet campaign for the general public. The website was designed for two purposes: to disseminate project findings to practitioners and to provide an information resource for clients. Focus groups with clinicians and clients took place in May 2013. The team received constructive feedback on the design of the website and the leaflet. In the meetings it was decided that the leaflet would be passed to the Clinical Genetic Services of Hong Kong (Department of Health) for their consideration for use by medical professionals. | |||||||||||||||||||||||||||||||||||||||||||||||||||
| SCREEN ID: SCRRM00542 |