Abstract: The proposed study focuses on aspects of language and communication in pre-implantation genetic diagnosis (hereafter PGD) and genetic counseling (hereafter GC) settings in Hong Kong. PGD is a technique combining in-vitro fertilization (IVF) and genetic testing on an embryo, with the purpose of avoiding the transmission of genetic abnormalities or conditions to the next generation. The study will investigate the interactional and discourse strategies used in PGD and GC services for a variety of genetic conditions by a designated team of healthcare providers. The data collected will include video- or audio-recorded consultations between healthcare provider and clients. The research team will examine the ways in which specific discourse and linguistic strategies used by healthcare providers affects the ways in which information is presented to and comprehended by clients. Objectives: - To build a database of healthcare provider-client communication in PGD and GC settings in Hong Kong. - To examine in detail healthcare provider-client communication in PGD and GC consultations from an interactional perspective, e.g.: - How information delivery is accomplished - Kinds of relationships and power dynamics found among healthcare providers and clients, as demonstrated through language use - Verbal and non-verbal patterns of communication - Socio-cultural and ethnographic aspects of PDGD and GC in Hong Kong - To analyze the general effect of the PC and GC consultations on clients' ethical reasoning, with special emphasis on (group) decision-making in this setting. It is expected that more specific study objectives will be identified at later stages of this project when the data becomes available.

Abstract: This project explores the ways in which interlocutors in research interviews talk about end-of-life. The data are interviews with women diagnosed with ovarian cancer (and their close relatives) undertaken for another purpose, who self-initiate talk about death and dying. We consider how interviewees discursively navigate between positions readily available to them from dominant discourses around cancer and explore whether such talk reflects constraints for our interviewees, which could be addressed for their benefit. Objectives: - To examine the ways in which topics related to end-of-life are raised in the research interviews. - To explore the discourse strategies used by both interviewer and interviewees in the ongoing interaction related to death and dying. - To consider how the discourses relate to dominant discourses around cancer. - To present the findings in order to support healthcare professionals in facilitating their patients in discussing these topics.

Abstract: This project explores tele-genetic counseling in the context of genetic counseling in Hong Kong. Tele-genetic counseling is genetic counseling mediated by distant technologies, such as telephone or the internet (Abrams and Geier 2006). The project builds on previous work involving face-to-face genetic counseling, and is motivated by the need to explore new modes of counseling due to a growing demand for genetic counseling services coupled with the limitations of the available workforce, particularly in highly populated areas such as Hong Kong. Objectives: - To use established discourse analytic methodologies to examine tele-genetic counseling in Hong Kong. - To explore the complexities and challenges of tele-genetic counseling and how they are mediated by participants of these encounters, particularly how a distant mode of communication impacts client decision-making, and how counselors manage information delivery and maintain a non-directive stance. - To summarize the results of the study in a workshop for the genetic counseling community in Hong Kong. - To maintain a database of tele-genetic counseling for the purposes of research and training genetic counseling professionals. Findings: - The project took a communication-oriented perspective to investigate genetic counselling provided by distance (via telephone). In genetic counselling professionals meet with clients at risk of or diagnosed with a genetic disorder and discuss that disorder, clients’ risks and available testing. - While face-to-face counselling has been widely researched, the distant mode has not received much attention. In addition, until recently there has been little research on counselling in non-English dominant contexts such as Hong Kong. The project has shown that while in counselling by telephone the participants do not have access to non-verbal means of communication (e.g. gestures), they employ a range of linguistic/ communication strategies that help them meet the aims of these consultations. - The project has identified some major themes of tele-counselling, such as communicating risk and uncertainty; responsibility (professional and parental); explanation- and advicegiving; decision-making. It has investigated the issues of professional roles and responsibilities; and the specifics of counselling in the designated non-English dominant context. - The projects findings have been disseminated at local and international events (for language scholars and professionals) and published in prestigious international journals and edited collections. The findings have also been incorporated into teaching and training activities for medical students and professionals.

Abstract: The Prenatal Screening for Down's Syndrome project explored English as a lingua franca between healthcare professionals and clients in prenatal genetic counseling in Hong Kong. A language that is ‘lingua franca’ is a bridge language used when two people or groups of people do not have the same native language. In this case, English was used between Hong Kong medical professionals, whose first language is Cantonese, and non-Cantonese speaking patients. The research team collected authentic interactions between non-native English speaking healthcare providers (doctors and nurses) and female clients of diverse backgrounds who used English as their native or non-native language. The team investigated how participants engaged in three critical activities of prenatal counseling: information delivery, advice giving, and decision making. Objectives: - To examine how English was used as lingua franca in prenatal genetic counseling in Hong Kong. - To investigate the wide range of discourse strategies used to facilitate communication within the analyzed context. - To investigate the specific interactional means by which participants direct prenatal counseling encounters using English as lingua franca. - To determine which contextual factors have an impact on how prenatal genetic counseling encounters unfold. - To present the findings to medical professionals of Hong Kong to disseminate new information and knowledge for professional development. Findings: - The research team found three critical activities being performed in prenatal counseling: information delivery, advice giving, and decision making. In addition to the language factor (i.e. English as lingua franca), a complex set of contextual factors had an impact on how these interactions unfolded: cultural factors, socioeconomic factors, and institutional factors appeared to be particularly prominent. The team also investigated a wide range of discourse strategies that facilitated communication in these counseling encounters. Both verbal (e.g. initial inquiries, perspective display series, hypothetical scenarios) and nonverbal (e.g. laughter) strategies were observed as means of communication. Participants also used specific methods of structuring discourse to achieve the main objective of prenatal counseling: for the female patient to arrive at an informed decision of whether to pursue prenatal screening and testing. - The research team also found other themes and trends within the collected data. For example, it was found that within the observed context, Hong Kong health providers tended to be more directive than in comparable settings in other countries (as reported in relevant literature), and that women and their family members had a higher expectation to be directed by healthcare providers in the decision-making process. The results of these observation was reported in a series of papers, in which the team reported the specific interactions means by which participants expressed their agendas and concerns (see, Zayts et al. 2012, Pilnick and Zayts 2012, Zayts and Schnurr 2012 in professional resources). - The results of this study were also summarized and presented to professionals in Hong Kong in July 2010. The workshop was attended by healthcare professionals from the main hospitals in Hong Kong, as well as professionals working in the private sector. Three international speakers also shared their experience of working in and researching in prenatal genetic in the UK (Angus Clarke, Allison Pilnik, Srikant Sarangi). The workshop was enthusiastically received and led to further collaborative activities (e.g. research seminars, workshops, pilot studies, funded projects). - One of the main outcomes of the project was that the research team established solid collaborative ties with several hospitals, the Clinical Genetic Counseling Services, and private practitioners, as well as a mutual acknowledgement of the importance of collaborative work between medical professionals and linguists. The project has drawn attention to the importance of this genre of work, to the substantial impact that such research can have on professional practice, and to the unique multi-cultural and multi-lingual context of Hong Kong.

Abstract: The proposed project aims to investigate risk communication and decision-making in the context of genetic counseling for Sudden Arrhythmia Death Syndrome (hereafter SADS) in Hong Kong. The data would be drawn from consultations with clients diagnosed with or at risk of developing SADS-related genetic conditions. A key focus of the study will be how professionals facilitate clients’ decision-making about testing and disclosure of test results. The primary data comprised of approximately 50 authentic, video-recorded genetic counseling consultations will be supplemented by follow-up interviews with professionals and clients, observations of the research site, and relevant organizational documents. Using discourse analytic methods, we will explore the central themes of risk communication and decision making that were identified in the pilot study of the project. These themes include risk explanations, uncertainty management, reassurance, and family decision-making. We will examine the dynamics of risk communication “diachronically”: we will recruit clients within the same family to examine how risk communication changes across subsequent sessions. We will also investigate risk communication in two formats: face-to-face (genetic counselling sessions) and follow-up written communication (e.g. pre- and post-test counselling letters). We will research discourse and rhetorical communication strategies that professionals employ to facilitate risk communication. Ultimately, the project aims to identify how risk communication influences the (non-)uptake of genetic testing. Objectives: - To use established discourse analytic methodologies to examine risk communication and its impact on clients’ decision-making in genetic counselling for SADS in Hong Kong. - To examine how risk communication and decision-making are contingent upon the sociocultural context in which the genetic counselling is situated. - To explore the central themes of genetic counselling for SADS relevant to risk communication and decision-making. - To examine how the interdisciplinary team constellation (genetic counselor, cardiologist) impacts risk communication and decision-making. - To contribute to professional training and education, and policy making by identifying and disseminating effective practices of genetic counselling for SADS. - To raise the public awareness about SADS through developing Hong Kong specific client information sources (written and online) and organizing a SADS awareness week. - To build up a database of genetic counselling consultations for SADS for the purposes of professional training and education. 突發心律失常死亡綜合症 （SADS） 簡介： 本研究項目就突發心律失常猝死綜合症（以下簡稱為SADS ）在香港的遺傳諮詢服務，探討有關此病症的風險溝通和決策，並於SADS確診病人或高風險人士的診症期間收集數據。本研究其中一個重點是要了解醫護人員如何協助應診人士決定是否接受測試和透露測試結果。 主要數據包括大約50段遺傳諮詢的錄影片段，加上與醫護人員和應診人士的後續訪問、對研究現場 (診症室) 的觀察資料和相關文件。運用話語分析的方法，我們將探討試點研究所指出的有關風險溝通和決策的中心主題。這些主題包括風險的解釋、不確定性的管理、給予應診人士安慰和家庭決策。我們將「歷時性」地研究風險溝通在一段時間內的變化：我們招募與應診人士來自同一家族的家人，研究風險溝通在經過之後的診症會有怎樣的變化。我們也研究風險溝通的兩種模式：會面式（遺傳諮詢服務）和書面交流（例如遺傳測試前後的輔導信件） ；研究醫護人員應該使用的話語和修辭的溝通策略，以促進風險溝通。最後，本研究亦會分析風險溝通如何影響遺傳基因測試的（不）接受率。 目標： - 使用既定的話語分析方法來研究風險溝通及它怎樣影響香港的病人在SADS遺傳諮詢期間作出決定 - 研究風險溝通和病人決策如何受社會文化背景影響 - 探索SADS遺傳諮詢服務與風險溝通和決策相關的中心主題 - 研究跨學科團隊（遺傳諮詢人員和心臟病專家）如何影響風險溝通和決策 - 通過識別和傳播SADS遺傳諮詢服務的有效做法，以促進職業培訓和教育，以及政策的制定 - 透過建立針對香港病人的資源（包括書面和網上）和舉辦SADS宣傳週，從而提高公眾對SADS的意識 - 建立SADS遺傳諮詢服務的數據庫，以專業培訓和教育為目的

Abstract: TCM is a growing global phenomenon. Despite its historical role in Chinese society, limited research explored TCM practitioner-patient interactions. Objective: To investigate the effectiveness of an intervention enhancing TCM practitioners' communication skills. Hypothesis: After controlling for baseline scores, TCM practitioners receiving training will integrate patients’ Western medical history into TCM treatment and show improved clinical communication skills. Design: pre-, post- and delayed post-test. Intervention: 8 Cantonese-speaking registered TCM practitioners in HK will be recruited in HA tripartite clinics (with TCM training qualifications in mainland China, and in three universities: HKU, CUHK, HKBU), and randomised into control (n=51) and experimental groups (n=51). The experimental group will be trained in patient-centred communication, with an internationally recognised and validated framework on taking Western medical history and communicating diagnosis and treatment plans. Consultations before and after training will be video-recorded and the quality of the interactions rated. The training will be evaluated by comparing the two groups before, immediately, and at 3 months after training. Instruments: validated, internationally recognised scales for measuring practitioners' clinical communication skills and the quality of interactions; measures of patient satisfaction, compliments and understanding of their treatment; structured questionnaire asking about practitioners’ ages, qualifications, experience and prior knowledge of western medicine. Expected results: The proposed intervention is expected to improve patient-centred communication and proficiency and to result in better care through the integration of patient’s Western medical history. The results will be used to develop and validate a communication model integrating TCM.

Abstract: This is the first project of its kind in Hong Kong that is aimed at changing the mental health situation in Hong Kong workplaces through linking high impact evidence-based qualitative and quantitative research findings about the knowledge, attitudes and behaviors towards mental health with culture-specific effective strategies of creating a healthy mental health working environment. The main target beneficiaries are working professionals and workplaces in Hong Kong, and the impact will be delivered through running a Mental Health Awareness event, and active dissemination of research findings to: (a) key stakeholders in participating workplaces, such as HR and other relevant departments, organizational psychologists, etc.; and (b) wider local and international academic and professional communities.