Decision-making about testing in intercultural genetic counselling encounters in Hong Kong

Abstract

There is a rich tradition of research on the role of culture in genetic counseling in medical sociological, anthropological, educational and genetic counselling literature. A common theme in existing studies is that culture has a significant impact on clients’ decision-making. Most of these studies, however, tend to view culture as a static concept and make ‘grand generalizations’ about its impact while over-looking how culture is actually oriented to by interlocutors on the micro-level of an interaction. In this paper, we explore the impact of participants’ cultural backgrounds on decision-making about testing in genetic counselling encounters. Using theme-oriented discourse analysis (Robert and Sarangi, 2005) we examine more than 150 video-recorded consultations from several public hospitals and a specialist clinic in Hong Kong. The participants include Hong Kong Chinese healthcare professionals and clients and family members from a variety of cultural backgrounds. While the data shows some tendencies in decision-making trajectories that are typically generalized in terms of cultural differences (e.g. decision-making dominated by male or elder family members in Asian families), we are primarily interested in examining various rhetorical and interactional means though which participants negotiate and construct their decisions. We thus look ‘beyond culture’ and also explore other factors that have an impact on the observed trajectories of decision-making, such as participants’ language proficiency and contextual knowledge of genetic counselling. We also show that in cases of low language proficiency of a family member when clients code-switch to their native language, rather than hindering communication, it facilitates clients’ autonomous decision-making.