{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T11:53:59Z","timestamp":1791978839218,"version":"4.4.0"},"reference-count":63,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T00:00:00Z","timestamp":1791936000000},"content-version":"vor","delay-in-days":13,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000051","name":"National Human Genome Research Institute","doi-asserted-by":"publisher","award":["R01HG011916"],"award-info":[{"award-number":["R01HG011916"]}],"id":[{"id":"10.13039\/100000051","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","award":["UL1TR002494"],"award-info":[{"award-number":["UL1TR002494"]}],"id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Genetic Counseling"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>The rapid integration of genomic medicine into clinical care has created an unprecedented demand for genetic counseling (GC) services. Attempts to streamline care have involved integration of GC assistants, group counseling sessions, and development of educational technology supplements; meanwhile, improving the efficiency of the core clinical interaction itself remains understudied. This study will evaluate the GC\u2010PRO Intervention, a targeted communication training for genetic counselors designed to optimize visit time by aligning counseling with patient\u2010centered needs and removing processes that do not contribute to positive patient experiences. Using a stepped\u2010wedge cluster randomized trial design across clinical specialties (e.g., prenatal, cancer, cardiology, and general genetics) at two academic health centers, we will recruit approximately 20 genetic counselors and 994 patients. To ensure the intervention and study design are culturally responsive, we are utilizing a community\u2010based participatory research approach with four multicultural community advisory boards. The intervention training focuses on three evidence\u2010based communication skills: Tailoring (assessing and integrating patient needs and values), Streamlining (reducing time spent gathering patient medical and family history information), and Main Messaging (reducing lecturing through increasing conversational exchanges). The primary outcome is visit time, and secondary outcomes include patient\u2010reported measures of empowerment, activation, trust, working alliance, patient\u2010centered communication, and overall satisfaction. Data will be analyzed using linear and generalized mixed\u2010effects models to compare the intervention to standard of care, accounting for calendar time, counselor nesting, and pre\u2010specified patient characteristics to improve precision. We hypothesize that this intervention will significantly reduce average visit time while maintaining or improving session quality, as measured against pre\u2010specified non\u2010inferiority thresholds. With 80% power to detect a 5\u2010min difference in session length, this study aims to provide a scalable framework for efficient GC services without sacrificing the counselor\u2010patient relationship or patient\u2010centered outcomes.<\/jats:p>","DOI":"10.1002\/jgc4.70297","type":"journal-article","created":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T11:42:17Z","timestamp":1791978137000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Maintaining Quality of Genetic Counseling Services While Maximizing Efficiency: Protocol for the\n                    <scp>GC<\/scp>\n                    \u2010\n                    <scp>PRO<\/scp>\n                    Intervention Stepped\u2010Wedge Cluster Randomized Trial"],"prefix":"10.1002","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3620-2857","authenticated-orcid":false,"given":"Deborah","family":"Cragun","sequence":"first","affiliation":[{"name":"College of Public Health University of South Florida  Tampa Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7560-1826","authenticated-orcid":false,"given":"Elena R.","family":"Fisher","sequence":"additional","affiliation":[{"name":"Department of Genetics, Cell Biology, and Development University of Minnesota  Minneapolis Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7711-9657","authenticated-orcid":false,"given":"Ashley","family":"Petersen","sequence":"additional","affiliation":[{"name":"Division of Biostatistics and Health Data Science University of Minnesota  Minneapolis Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1941-664X","authenticated-orcid":false,"given":"Heather A.","family":"Zierhut","sequence":"additional","affiliation":[{"name":"Department of Genetics, Cell Biology, and Development University of Minnesota  Minneapolis Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,14]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pec.2023.107889"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10897\u2010016\u20100053\u20108"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/jgc4.1466"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.2196\/jmir.3085"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2021.689927"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10897\u2010017\u20100180\u2010x"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10897\u2010018\u20100249\u20101"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2005.04.050"},{"key":"e_1_2_11_10_1","unstructured":"Chang W. J.Cheng J.Allaire et\u00a0al.2025.\u201cshiny: Web Application Framework for R.\u201d[Computer Software].https:\/\/doi.org\/10.32614\/CRAN.package.shiny.https:\/\/CRAN.R\u2010project.org\/package=shiny."},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11606\u2010008\u20100520\u20105"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/pd.5149"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.30621"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10897\u2010017\u20100145\u20100"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/jgc4.2002"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1037\/0022\u20103514.44.1.113"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/jgc4.1815"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1186\/1472\u20106963\u20105\u201064"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pec.2007.11.026"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1002\/jgc4.1378"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen\u20102024\u2010085472"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1002\/jgc4.1999"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajmg.c.31599"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1053\/ejso.2002.1270"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejmg.2018.11.015"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1002\/jgc4.1265"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1177\/1077558702059003004"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41436\u2010020\u20100797\u20102"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1475\u20106773.2003.00190.x"},{"key":"e_1_2_11_30_1","doi-asserted-by":"publisher","DOI":"10.1080\/10503300500352500"},{"key":"e_1_2_11_31_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1475\u20106773.2005.00438.x"},{"key":"e_1_2_11_32_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471\u20102350\u201015\u201033"},{"key":"e_1_2_11_33_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11121\u2010023\u201001587\u20101"},{"key":"e_1_2_11_34_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.27695"},{"key":"e_1_2_11_35_1","volume-title":"Crossing the Quality Chasm: A New Health System for the 21st Century","author":"Institute of Medicine (US) Committee on Quality of Health Care in America","year":"2001"},{"key":"e_1_2_11_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pec.2013.09.016"},{"key":"e_1_2_11_37_1","doi-asserted-by":"publisher","DOI":"10.1111\/risa.12600"},{"key":"e_1_2_11_38_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejmg.2018.12.004"},{"key":"e_1_2_11_39_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gim.2022.07.025"},{"key":"e_1_2_11_40_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10897\u2010017\u20100089\u20104"},{"issue":"1","key":"e_1_2_11_41_1","first-page":"81","article-title":"Jefferson Scale of Patient's Perceptions of Physician Empathy: Preliminary Psychometric Data","volume":"48","author":"Kane G. C.","year":"2007","journal-title":"Croatian Medical Journal"},{"key":"e_1_2_11_42_1","doi-asserted-by":"publisher","DOI":"10.17294\/2330\u20100698.1562"},{"key":"e_1_2_11_43_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399\u20100004.2011.01636.x"},{"key":"e_1_2_11_44_1","doi-asserted-by":"publisher","DOI":"10.1111\/1468\u20100009.12654"},{"key":"e_1_2_11_45_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cct.2021.106432"},{"key":"e_1_2_11_46_1","doi-asserted-by":"publisher","DOI":"10.1200\/PO.21.00233"},{"key":"e_1_2_11_47_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0279725"},{"key":"e_1_2_11_48_1","doi-asserted-by":"crossref","first-page":"9507","DOI":"10.18653\/v1\/2024.findings-emnlp.555","volume-title":"Findings of the Association for Computational Linguistics: EMNLP 2024","author":"Nguyen V.","year":"2024"},{"key":"e_1_2_11_49_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12687\u2010026\u201000897\u20105"},{"key":"e_1_2_11_50_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10897\u2010016\u20100039\u20106"},{"key":"e_1_2_11_51_1","volume-title":"R: A Language and Environment for Statistical Computing","author":"R Core Team","year":"2021"},{"key":"e_1_2_11_52_1","doi-asserted-by":"publisher","DOI":"10.1002\/jgc4.1352"},{"key":"e_1_2_11_53_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10897\u2010015\u20109864\u20102"},{"key":"e_1_2_11_54_1","doi-asserted-by":"publisher","DOI":"10.1186\/1479\u20105868\u20109\u201019"},{"key":"e_1_2_11_55_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2022.11.021"},{"key":"e_1_2_11_56_1","doi-asserted-by":"publisher","DOI":"10.1002\/jgc4.1230"},{"key":"e_1_2_11_57_1","doi-asserted-by":"publisher","DOI":"10.3390\/jpm9030033"},{"key":"e_1_2_11_58_1","doi-asserted-by":"publisher","DOI":"10.1158\/1055\u20109965.EPI\u201023\u20100596"},{"key":"e_1_2_11_59_1","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0b013e3182652482"},{"key":"e_1_2_11_60_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13012\u2010017\u20100635\u20103"},{"key":"e_1_2_11_61_1","doi-asserted-by":"publisher","DOI":"10.1002\/jgc4.1554"},{"key":"e_1_2_11_62_1","doi-asserted-by":"publisher","DOI":"10.1002\/jgc4.1557"},{"key":"e_1_2_11_63_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pec.2022.03.009"},{"key":"e_1_2_11_64_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10897\u2010015\u20109930\u20109"}],"container-title":["Journal of Genetic Counseling"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jgc4.70297","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/jgc4.70297","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jgc4.70297","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T11:42:23Z","timestamp":1791978143000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/jgc4.70297"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10]]},"references-count":63,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1002\/jgc4.70297"],"URL":"https:\/\/doi.org\/10.1002\/jgc4.70297","archive":["Portico"],"relation":{},"ISSN":["1059-7700","1573-3599"],"issn-type":[{"value":"1059-7700","type":"print"},{"value":"1573-3599","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10]]},"assertion":[{"value":"2026-03-27","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-23","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-14","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70297"}}