Empowering the "Empowerers": An Evaluation of Empowerment of Genetic Counselors in Patient-Facing Roles in Canada.

Empowerment of healthcare professionals can be described as having the agency and motivation to use one's expertise to its greatest effect in one's practice. The purpose of this study was to explore professional empowerment of genetic counselors (GCs) in patient-facing roles in Canada. This was a pragmatically oriented, mixed methods study with an explanatory sequential design. The overarching research question was: What factors impact empowerment of patient-facing GCs in Canada and how do these factors interrelate? We recruited GCs in patient-facing roles in Canada (currently or within 5 years). Forty-nine participants completed a demographic survey and two quantitative validated scales to measure structural empowerment (CWEQ-II scale, workplace conditions) and psychological empowerment (PEI scale, intrinsic motivation). Associations between demographic/workplace factors and empowerment scores were identified using linear regression. A subset of participants was purposively sampled for semi-structured interviews using maximum variability sampling. Themes were generated from 12 interview transcripts by reflexive thematic analysis. Quantitative and qualitative data were integrated using a compare-and-contrast method. Factors associated with greater structural empowerment included having a vision statement for the clinical unit and always working at top-of-scope. Having 11-20 years of practice compared to less than five was associated with greater psychological empowerment. Working at top-of-scope often, a supportive workplace culture, and job satisfaction were factors associated with both structural and psychological empowerment. Data integration yielded five concepts related to GC empowerment: (1) supportive working relationships are crucial for GC empowerment, (2) empowered GCs have clearly defined roles and responsibilities, (3) balancing the goals of the individual GC with those of the institution promotes GC empowerment, (4) empowering GCs can improve patient care, and (5) self-efficacy as a component of empowerment. This study lays the foundation for future development and evaluation of interventions to promote GC empowerment and potentially improve patient care.