FOCUS has been updated!  Please see the following article for the revised version. Zale, et. al., Revising the FOCUS framework through a qualitative study assessing self-reported counseling skills of genetic counselors (2022). Revisions were made based on interviews with practicing genetic counselors and included the consolidation of the process domain categories from 13 to 10. Minor changes were also made to the descriptions and inclusion criteria for a few categories.

The original publication on the development of FOCUS can be found here:  Cragun, D. & Zierhut, H. Development of FOCUS-GC: Framework for Outcomes of Clinical Communication Services in Genetic Counseling.  J. Genet Counsel (2017).

What is the Framework for Outcomes in Clinical Communication Services (FOCUS)?

FOCUS is a framework that categorizes and defines a broad array of “outcomes” and communication processes related to patient counseling, patient education, health coaching and care-coordination. FOCUS helps depict how clinical communication may influence patients and families either directly or indirectly and ultimately improve patient health and well-being.

FOCUS was designed to help healthcare providers, researchers, or other stakeholders:

  • Develop ideas about how to evaluate clinical communication services (specifically genetic counseling)
  • Select which goals and “outcomes” are of most interest to different stakeholders
  • Hypothesize how communication processes might contribute to “outcomes”
  • Design a strategy by combining communication processes that may improve patient care experiences or influence specific “outcomes”

For genetic counselors this framework may eventually help answer questions like:

How is FOCUS organized?

FOCUS (illustrated in the figure above) consists of six domains with several categories in each domain. The framework suggests possible relationships between domains and categories. More work is needed to summarize existing data and collect new data that would support or refute the proposed relationships.

How do I get started using FOCUS?

Select from any of the following to get started:

  • Learn about the FOCUS domains and categories by exploring an interactive figure
  • Apply FOCUS in your research, practice or teaching using a step-by-step guide to select patient care experiences or outcomes of interest to you or to develop a communication strategy
  • View a concrete example of how the framework can be used
  • Find out more about how FOCUS may relate to health care quality

Note: We use the term “outcomes” in quotes to indicate various cognitive, emotional, or behavioral changes that can occur among patients and family members in addition to changes in their health. These can be measured using patient-reported measures or subjective measures. This is in contrast to the United States Agency for Healthcare Research Quality (AHRQ) in which “an outcome of care is a [subjective] health state of a patient resulting from health care”.  AHRQ recognizes that there are other clinical quality measures, besides outcomes, but they use different terminology to refer to “patient reported outcomes” and other types of quality health care indicators.

How does FOCUS relate to genetic counseling skills?

The FOCUS process domain was used to help categorize multiple skills that genetic counselors report using in their practice. Many of these skills were compiled into the Genetic Counseling Skills Checklist which is currently being used in research as a way to capture and describe practice variability across genetic counselors and across sessions.

How has FOCUS been adapted for Genetic Counselors Working in Industry?

An analogous version of FOCUS is visualized below and links to tables for Industry can be found in the Tables and Resources tab. Examples illustrating how FOCUS has been used to conceptualize outcomes in industry are also available.