Research design
We carried out a convergent mixed-methods pilot feasibility examine. Quantitative and qualitative knowledge have been collected concurrently and given equal significance in assessing feasibility, acceptability, and preliminary impression. Integration occurred throughout interpretation by way of triangulation of quantitative and qualitative findings. The design comprised three phases: (1) pre-intervention analysis, (2) intervention part, and (3) post-intervention analysis.
Moral approval
The protocol was submitted and authorized by the ethics committee of Hospital de Braga and of i3S. We obtained knowledgeable consent from all members. Confidentiality and anonymity have been assured.
Individuals and recruitment
Individuals have been professionals who offered genetic counselling inside Portuguese genetic providers, together with genetic counsellors, medical geneticists, and genetic nurses concerned in counselling actions. Recruitment focused public genetics healthcare providers throughout the Portuguese Nationwide Well being Service (SNS), which comprised 5 public genetics providers and genetics departments that don’t maintain formal service standing [21]. Invites have been despatched through e mail to eight service administrators, who have been invited to take part or nominate group members for the pilot GCS mission.
Inclusion standards: lively engagement in genetic counselling apply; willingness to decide to GCS schedule; consent to take part.
Exclusion standards: genetics professionals circuitously concerned in provision of genetic counselling (laboratory roles, analysis or administrative features).
Intervention
This GCS pilot was primarily based on established rules described lately [22] and applied by way of group supervision periods grounded in a story method [20, 23].
The intervention was structured round three core parts: (1) an oral supervisory settlement defining roles, confidentiality, objectives, and expectations; (2) narrative-based group GCS; and (3) a secure, non-judgemental, peer-supported atmosphere, moderated by a supervisor with experience in GCS.
The programme adopted a structured format, together with an preliminary immersion session introducing goals, format, and group agreements, adopted by 4 on-line periods (roughly 90 min every), every centred on one participant-selected real-life case.
All periods have been facilitated by the identical supervisor (MFD), a professional systemic and narrative practitioner with in depth experience in narrative genetic counselling supervision.
Supervision adopted a predefined narrative-informed construction primarily based on the outsider witness mannequin described by Ferrer-Duch et al. [20]. In every session, one participant offered a case whereas the remaining members acted as lively observers. Chosen members (outsider witnesses) then shared structured reflections, adopted by a bunch dialogue to advertise reflection, collaborative studying, and that means making. Reflections targeted on resonant facets of the case, the private {and professional} meanings evoked, and implications for future medical apply. Given the pilot nature of the intervention, formal constancy monitoring procedures weren’t applied. Nevertheless, all periods adopted the identical predefined supervision construction and have been facilitated by the identical supervisor to make sure consistency of supply throughout the programme.
Devices
Psychological well-being, stress, anxiousness, and despair measures
Individuals’ psychological well-being, perceived stress, anxiousness, and depressive signs have been assessed utilizing Melancholy, Anxiousness and Stress Scale—21 Objects [24]. DASS-21 is a short self-report instrument composed of 21 gadgets distributed throughout three subscales.
This instrument was administered at pre-intervention and post-intervention.
Genetic counselling high quality evaluation scale
Perceived high quality of apply in genetic counselling was assessed by way of self-report utilizing Dimensions 2 and three of the Genetic Counselling High quality Evaluation Scale [25], which give attention to communication processes and relational facets of genetic counselling.
The dimensions was administered at pre-intervention and post-intervention.
Temporary working alliance questionnaire
The working alliance with the supervisor was assessed utilizing the Temporary Working Alliance Questionnaire [26].
Throughout the intervention, the questionnaire was administered instantly following every GCS session and at post-intervention to observe the event of the supervisory working alliance.
Written narratives of difficult instances
Previous to the intervention, members have been requested to supply between 5 and ten temporary written narratives describing latest emotionally troublesome or ethically difficult counselling instances. These narratives have been launched as a preparatory reflective train prompt by the supervisor to familiarise members with narrative reflection earlier than supervision periods. They weren’t included within the formal qualitative evaluation.
Session analysis questionnaire
Individuals’ perceptions and satisfaction with every GCS session have been assessed utilizing a short questionnaire developed particularly for this examine. The questionnaire was validated by a group of specialists concerned within the design and improvement of the pilot mission. (Appendix 1). This was adopted by an open-ended query asking members to establish three key take-home messages from the session.
Semi-structured interviews
Qualitative knowledge have been collected by way of semi-structured interviews carried out at two time factors. At pre-intervention, interviews explored difficult medical instances, earlier experiences with supervision, expectations, and perceived skilled wants (Appendix 2). At post-intervention, particular person retrospective interviews targeted on members’ experiences of GCS programme and perceived impacts (Appendix 3).
Ultimate focus group
At post-intervention, members took half in a last focus group. The session was designed to discover shared experiences of the supervision programme, perceived impacts on medical apply {and professional} well-being, and proposals for future implementation (Appendix 4).
Information assortment procedures
Information assortment was carried out utilizing on-line and hybrid codecs. Quantitative questionnaires have been administered electronically through Google Kinds, utilizing safe hyperlinks. Individuals have been knowledgeable that responses have been confidential, dealt with solely by the analysis group, and never accessible to the supervisor.
To allow matching of pre and put up intervention responses whereas preserving confidentiality, members have been assigned a singular identification quantity in the beginning of the examine and requested to make use of it throughout all devices. Information have been pseudonymised.
Semi-structured interviews have been carried out on-line through Microsoft Groups, audio-recorded with consent, and robotically transcribed, with transcripts reviewed for accuracy.
The ultimate focus group was carried out in a hybrid format, with in-person and on-line participation. MP and LG moderated the session utilizing a semi-structured information exploring perceptions of the GCS pilot.
All knowledge assortment procedures have been carried out in Portuguese. Qualitative knowledge have been initially analysed in Portuguese to protect semantic depth and contextual that means. Subsequently, chosen excerpts and illustrative quotes have been translated into English for reporting and publication functions. Translation was carried out by members of the analysis group fluent in each languages. The timing of knowledge assortment throughout all phases and its alignment with GCS periods is offered in Fig. 1.
Legend: The pilot motion consisted of three phases: (1) pre-intervention; (2) group on-line GCS and (3) post-intervention. DASS-21 Melancholy Anxiousness Stress Scales-21, GCQAS Genetic Counselling High quality Evaluation Scale, GCS Genetic Counselling Supervision.
Information evaluation
To make sure methodological readability, findings are offered distinguishing between qualitative participant studies, quantitative outcomes, and interpretative dialogue. Qualitative knowledge replicate members perceived experiences, quantitative knowledge seek advice from measured outcomes, and interpretative statements are explicitly recognized when extending past the empirical findings.
Quantitative knowledge have been analysed utilizing descriptive statistics (means, M and normal deviations, SD), and adherence charges (session attendance and completion of questionnaires). Lacking questionnaire knowledge weren’t imputed, and analyses have been carried out utilizing available-case evaluation. Consequently, the pattern measurement diversified throughout assessments relying on questionnaire completion. One participant didn’t full the baseline DASS-21 questionnaire and was subsequently excluded from the descriptive statistics for that particular evaluation. Qualitative knowledge have been analysed utilizing thematic evaluation of semi-structured interviews, following the method described by Braun and Clarke (2006) [27]. Interview transcripts have been learn iteratively to make sure familiarization with the information, and preliminary codes have been generated inductively. Codes have been then grouped into broader themes by way of an iterative technique of comparability and refinement. The event of themes was mentioned among the many analysis group, specifically LG and MP, to reinforce analytical rigour and consistency. Discrepancies have been resolved by way of dialogue till consensus was reached. Provided that the worth of GCS is commonly subjective, relational, and experiential, the qualitative element was important for capturing these dimensions. Reflexivity was addressed by way of ongoing discussions among the many analysis group relating to assumptions, skilled backgrounds, and potential influences on interpretation. LG is a psychologist and researcher with postgraduate coaching in genetic counselling and a specific curiosity in genetic counselling supervision. MP is a senior researcher, genetic counsellor, and educator with in depth expertise in genetic counselling apply and coaching. All through the evaluation, the group thought-about how these backgrounds would possibly form interpretation, discussing rising themes collaboratively to reinforce reflexivity and analytical rigour. Though some researchers have been professionally recognized to members by way of the Portuguese genetics’ group, no hierarchical or evaluative relationships existed.
The genetic counselling supervisor was not concerned in knowledge assortment, coding, or evaluation, had no entry to members’ questionnaire responses, and had no pre-existing supervisory relationships with members earlier than the intervention. Integration of mixed-methods knowledge was carried out by way of triangulation of quantitative indicators with qualitative themes to supply a complete evaluation of the programme’s feasibility, acceptability, and preliminary impression.
