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What exactly does an NCCS genetic counsellor do?

Ms Shao-Tzu Li, Senior Genetic Counsellor in the Cancer Genetics Service at the National Cancer Centre Singapore (NCCS), answers five questions on what it takes to be a genetic counsellor and how counselling patients empowers them to make informed health decisions.

1. What did you study to become a genetic counsellor?

It was during my first job in a biotechnology company that I found out that there was a profession to be a genetic counsellor. A role, straddling science and people skills - that seemed like the best fit for me.

I applied to do my masters in genetic counselling in the United States, where the field was born. Initially, I was rejected by all 10 schools that I applied to! When I asked what I was lacking, they replied I didn’t have relevant experience. So, I got a job for two years as a research coordinator in a rare disease centre to learn about different genetic conditions. The second time I applied I was accepted to the Master of Science in the Genetic Counselling Program at the Icahn School of Medicine at Mount Sinai in New York.

In my two years of training, we studied genetic and genomic knowledge and a multitude of genetic conditions across different areas such as Down syndrome, Phenylketonuria and Marfan syndrome, to name a few. I also learnt counselling skills and empathy which are invaluable for genetic counselling. Sometimes we have patients who are frustrated because they are sick and feel that being diagnosed with a genetic condition is unfair. Empathy helps me appreciate that they are facing a difficult situation, understand why they are upset and treat them with sensitivity.

2. How did you become a genetic counsellor at NCCS?

When it came time to graduate I wanted to return to Asia to pursue my career. One of my classmates referred me to an online advertisement for a genetic counsellor position at NCCS.

I applied for the position and Joanne (referring to Associate Professor Joanne Ngeow, Head of Cancer Genetics Service, NCCS) wrote to me that same day. She was coming to New York for work and asked if I wanted to meet that weekend. We met and it was clear that she was passionate about the work being done in NCCS in cancer genetics. The next day she offered me the job and I took it. As a Taiwanese, my perception of Singapore was and is very positive, and I was excited for the job opportunity.

 

Ms. Shao Tzu Li (right), Senior Genetic Counsellor and Assoc Prof Joanne Ngeow, Head, Cancer Genetics Service, National Cancer Centre Singapore, at Run for Hope 2016 to raise awareness and support for cancer research.

3. What was it like starting a job at NCCS as a genetic counsellor and counselling patients?

I started in July 2015 as one of the few counsellors in the division and the learning curve was steep! The practice is very different from the theory, I had to have a lot of information at my fingertips such as the type of cancer the patient is affected by, the staging of their cancer, treatment regime, drugs and more. It took about a year for me to get comfortable.

Even though I had clinical experience, the first few times I counselled patients were daunting. I prepared a template of things to say and ask them. For example, in a patient’s first session I usually explain the purpose of the visit, what the session will look like, take their family history and go through my assessment. I explain genetic testing and how knowing if they have a genetic condition can help them make decisions about their treatment and life. I then ask them whether they would like to proceed with genetic testing. We also counsel them after they get the results to help them understand their results. By going through this detailed process, we equip patients with the knowledge they need to make the right decision for themselves and their families.

 

The National Cancer Centre Singapore Cancer Genetics Service team pose for a photo in 2018.

4. What are your everyday responsibilities, as a genetic counsellor, in NCCS?

I would say 50% of my work is related to clinical work - counselling, case preparation and management. All genetic counsellors prep cases beforehand and we discuss them in our weekly team meetings. This is where the cancer genetics team, including the treating oncologists and research fellows, weigh in and discuss the best way to interpret results and manage the cases.

In addition, I currently lead a telemedicine research project, to evaluate whether video consultation is as effective as in-person genetic counselling. I am also on a panel that is working to map out structured career paths for genetic counsellors. I sometimes lecture nursing or polytechnic students and I do a lot of administrative work!

5. What is the most fulfilling part of your job?

I find many aspects of my job satisfying. Genetics is a fascinating and evolving field, in which you can learn something new and challenging every day. We spend a lot of time updating our knowledge of genetics so that we can best understand and convey how it impacts our patient’s care and clinical management. I feel especially fulfilled when patients understand genetic testing and their condition and feel the knowledge is useful to enable them to change their lives.