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Osborne A, Bland EM, Diamonstein C, Fishler K. Time tracking and comparison of genetic counseling tasks in inpatient and outpatient settings. J Genet Couns 2024. [PMID: 38922772 DOI: 10.1002/jgc4.1935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 05/28/2024] [Accepted: 05/28/2024] [Indexed: 06/28/2024]
Abstract
Genetic counselors (GCs) practice in critical care settings. Some GCs have full-time inpatient roles, while most GCs who see inpatients do so as needed or on a rotating schedule in addition to seeing patients in an outpatient setting. Few studies have tracked and compared the amount of time it takes GCs to perform tasks in the inpatient and outpatient settings. Genetic counselors were invited to participate in this study via the National Society of Genetic Counselors research listserv. Participants completed an online survey asking how their role is structured and what types of support are available to them while seeing inpatients. They also performed time tracking for 16 tasks known to be associated with inpatient and/or outpatient care via RedCap. These tasks include direct patient care, care coordination, and other tasks which encapsulate a new patient encounter from beginning to end. Forty-two inpatient encounters and 26 outpatient encounters were analyzed. The total average time spent on an inpatient consult (3 h and 38.5 min) was significantly higher than the time spent on an outpatient consult (2 h and 24.7 min; p < 0.05). Individually, genetic counselors spent significantly more time on the following tasks in an inpatient setting: direct follow-up encounters, multidisciplinary team communication, results disclosure encounters, results disclosure documentation, traveling, and waiting. Follow-up encounters, traveling, and waiting happen almost exclusively in inpatient settings. Short answer prompts regarding structure of GC role and available support revealed themes including lack of inpatient role structure, challenges with balancing between inpatient and outpatient tasks, and varied institutional support. These results promote further discussion about how to support GCs who see inpatients as these roles expand. Some suggestions include increased FTE/protected time and/or GCA support specific to the inpatient role.
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Affiliation(s)
- Alexandra Osborne
- Munroe-Meyer Institute for Genetics & Rehabilitation, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Emily Magness Bland
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA
| | - Callie Diamonstein
- Medical City Children's Hospital, Medical City Dallas Hospital, Dallas, Texas, USA
| | - Kristen Fishler
- Munroe-Meyer Institute for Genetics & Rehabilitation, University of Nebraska Medical Center, Omaha, Nebraska, USA
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2
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Fisher ER, Cragun D, Dedrick RF, Lumpkins CY, Ramírez M, Kaphingst KA, Petersen A, MacFarlane IM, Redlinger-Grosse K, Shire A, Culhane-Pera KA, Zierhut HA. Linking genetic counseling communication skills to patient outcomes and experiences using a community-engagement and provider-engagement approach: research protocol for the GC-PRO mixed methods sequential explanatory study. BMJ Open 2024; 14:e085472. [PMID: 38631834 PMCID: PMC11029319 DOI: 10.1136/bmjopen-2024-085472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 03/19/2024] [Indexed: 04/19/2024] Open
Abstract
INTRODUCTION In over 50 years since the genetic counseling (GC) profession began, a systematic study of GC communication skills and patient-reported outcomes in actual sessions across multiple clinical specialties has never been conducted. To optimize GC quality and improve efficiency of care, the field must first be able to comprehensively measure GC skills and determine which skills are most critical to achieving positive patient experiences and outcomes. This study aims to characterise GC communication skills using a novel and pragmatic measure and link variations in communication skills to patient-reported outcomes, across clinical specialties and with patients from diverse backgrounds in the USA. Our community-engagement and provider-engagement approach is crucial to develop recommendations for quality, culturally informed GC care, which are greatly needed to improve GC practice. METHODS AND ANALYSIS A mixed methods, sequential explanatory design will be used to collect and analyze: audio-recorded GC sessions in cancer, cardiac, and prenatal/reproductive genetic indications; pre-visit and post-visit quantitative surveys capturing patient experiences and outcomes and post-visit qualitative interview data. A novel, practical checklist will measure GC communication skills. Coincidence analysis will identify patterns of GC skills that are consistent with high scores on patient-reported measures. Two-level, multilevel models will be used to evaluate how GC communication skills and other session/patient characteristics predict patient-reported outcomes. Four community advisory boards (CABs) and a genetic counselor advisory board will inform the study design and analysis. ETHICS AND DISSEMINATION This study has been approved by the single Institutional Review Board of the University of Minnesota. This research poses no greater than minimal risk to participants. Results from this study will be shared through national and international conferences and through community-based dissemination as guided by the study's CABs. A lay summary will also be disseminated to all participants.
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Affiliation(s)
- Elena R Fisher
- Genetics, Cell Biology, and Development, University of Minnesota College of Biological Sciences, Minneapolis, Minnesota, USA
| | - Deborah Cragun
- University of South Florida College of Public Health, Tampa, Florida, USA
| | - Robert F Dedrick
- Educational and Psychological Studies, University of South Florida, Tampa, Florida, USA
| | - Crystal Y Lumpkins
- Huntsman Cancer Institute, Salt Lake City, Utah, USA
- Department of Communication, The University of Utah, Salt Lake City, Utah, USA
| | - Mariana Ramírez
- JUNTOS Center for Advancing Latino Health, University of Kansas Medical Center Department of Population Health, Kansas City, Kansas, USA
| | - Kimberly A Kaphingst
- Huntsman Cancer Institute, Salt Lake City, Utah, USA
- Department of Communication, The University of Utah, Salt Lake City, Utah, USA
| | - Ashley Petersen
- University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Ian M MacFarlane
- Genetics, Cell Biology, and Development, University of Minnesota College of Biological Sciences, Minneapolis, Minnesota, USA
| | - Krista Redlinger-Grosse
- Genetics, Cell Biology, and Development, University of Minnesota College of Biological Sciences, Minneapolis, Minnesota, USA
| | | | - Kathleen A Culhane-Pera
- SoLaHmo Partnership for Health and Wellness, Community-University Health Care Center, Minneapolis, Minnesota, USA
| | - Heather A Zierhut
- Genetics, Cell Biology, and Development, University of Minnesota College of Biological Sciences, Minneapolis, Minnesota, USA
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3
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Cohen SA, Nixon DM. Evaluating attributes of a collaborative model of service delivery for hereditary cancer risk assessment. J Genet Couns 2024; 33:291-300. [PMID: 37183788 DOI: 10.1002/jgc4.1722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 03/24/2023] [Accepted: 04/15/2023] [Indexed: 05/16/2023]
Abstract
The purpose of this nonrandomized study was to compare several attributes of hereditary cancer risk assessment using a collaborative model of service delivery. Arm 1 included patients seen in-person by a board-certified genetic counselor (CGC), Arm 2 included high-complexity triaged patients from distant sites who received telegenetics with a CGC, and Arm 3 included low-complexity triaged patients from distant sites who had in-person risk assessment with a locally placed genetic counselor extender (GCE). A total of 152 patients consented and 98 had complete data available for analysis (35 in Arm 1, 33 in Arm 2, and 30 in Arm 3). The three groups were comparable in age, ethnicity, education, employment, and cancer status. There was no significant difference in median wait time or distance traveled to receive care across all three arms. However, if patients in Arms 2 and 3 had to access the CGC in-person, they would have had to travel significantly further (p < 0.0001). The time spent in a session was significantly longer in Arm 3 with a GCE than with a CGC in-person or by telegenetics (p < 0.01). There was no difference in the number of essential elements covered in the appointment, change in cancer worry, or appointment satisfaction across all three arms, although the sample size was small. Employing a collaborative model of service delivery with GCEs and telegenetics is feasible, satisfactory to patients and reduces the distance patients travel to access hereditary cancer genetic services.
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Affiliation(s)
- Stephanie A Cohen
- Ascension St. Vincent, Cancer Genetics Risk Assessment Program, Indianapolis, Indiana, USA
| | - Dawn M Nixon
- Ascension St. Vincent, Cancer Genetics Risk Assessment Program, Indianapolis, Indiana, USA
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Capasso A, Nehoray B, Gorman N, Quinn EA, Bucio D, Blazer KR. Genetic counselors' and community clinicians' implementation and perceived barriers to informed consent during pre-test counseling for hereditary cancer risk. J Genet Couns 2024. [PMID: 38480478 DOI: 10.1002/jgc4.1887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 02/01/2024] [Accepted: 02/03/2024] [Indexed: 04/21/2024]
Abstract
As demand for genetic cancer risk assessment (GCRA) continues to increase, so does the sense of urgency to scale up efforts to triage patients, facilitate informed consent, and order genetic testing for cancer risk. The National Society of Genetic Counselors outlines the elements of informed consent that should be addressed in a GCRA session. While this practice resource aims to improve health equity, research on how well the elements of informed consent are implemented in practice is lacking. This retrospective and prospective mixed-methods study assessed how adequately the elements of informed consent are addressed during pre-test GCRA among 307 community clinicians (CC) and 129 cancer genetic counselors (GC), and barriers they face to addressing these elements. Results revealed that more than 90% of both cohorts consistently addressed components of at least 5 of the 10 elements of informed consent during a pre-test consultation. Technical aspects and accuracy of the test and utilization of test results were the most similarly addressed elements. Notably, GCs more often review the purpose of the test and who to test, general information about the gene(s), and economic considerations whereas CCs more often review alternatives to testing. Both cohorts reported psychosocial aspects of the informed consent process as the least adequately addressed element. Time constraints and patient-related concerns were most often cited by both cohorts as barriers to optimal facilitation of informed consent. Additional barriers reported by CCs included provider lack of awareness, experience, or education, and availability of resources and institutional support. Findings from this study may contribute to the development of alternative delivery models that incorporate supplementary educational tools to enhance patient understanding about the utility of genetic testing, while helping to mitigate the barrier of time constraints. Equally important is the use of this information to develop continuing education tools for providers.
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Affiliation(s)
- Alexandra Capasso
- School of Pharmacy and Health Sciences, Keck Graduate Institute, Claremont, California, USA
- Division of Clinical Cancer Genomics, City of Hope National Medical Center, Duarte, California, USA
| | - Bita Nehoray
- Division of Clinical Cancer Genomics, City of Hope National Medical Center, Duarte, California, USA
| | - Nicholas Gorman
- School of Pharmacy and Health Sciences, Keck Graduate Institute, Claremont, California, USA
| | - Emily A Quinn
- School of Pharmacy and Health Sciences, Keck Graduate Institute, Claremont, California, USA
| | - Daiana Bucio
- Clinical Consultation Services, Invitae Corporation, San Francisco, California, USA
| | - Kathleen R Blazer
- Division of Clinical Cancer Genomics, City of Hope National Medical Center, Duarte, California, USA
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Yoo B, Kim A, Moon HS, So MK, Jeong TD, Lee KE, Moon BI, Huh J. Evaluation of Group Genetic Counseling Sessions via a Metaverse-based Application. Ann Lab Med 2024; 44:82-91. [PMID: 37665289 PMCID: PMC10485865 DOI: 10.3343/alm.2024.44.1.82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/26/2023] [Accepted: 08/07/2023] [Indexed: 09/05/2023] Open
Abstract
Background Group genetic counseling has been implemented to meet growing demand. A metaverse platform, in which a society is built and activities are carried out in the virtual world, has not yet been implemented in group genetic counseling. We investigated whether a metaverse platform could be an alternative service-delivery model for group genetic counseling. Methods Participants (N=131) were divided into three groups: patient (N=45), family (N= 43), and interested (N=43) groups. Participants entered the metaverse through a link sent to their mobile phones and attended a 20-min group genetic counseling session reviewing hereditary breast cancer, followed by a 10-min question-and-answer period. Results The overall median score of post-educational knowledge (9.0, range 8.0-10.0) significantly increased compared to that of pre-educational knowledge (6.0, range 3.0-8.0) (P<0.001). There was no significant difference in the pre- and post-educational knowledge scores among the three groups (P>0.05). Most participants (95%) responded that their understanding of hereditary breast cancer had increased after the group genetic counseling session and that their satisfaction was high. The main advantage noted with metaverse was no limit of space and location while attending the session (97%), and the main disadvantage was a possibility of missing content due to an unstable internet connection (67%). Conclusions The metaverse platform would be acceptable as an alternative group genetic counseling service. More studies are needed to investigate how, for whom, and in what circumstances metaverse can be effectively utilized.
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Affiliation(s)
- Boeun Yoo
- Department of Genetic Counseling, College of Medicine Graduate School, Ewha Womans University, Seoul, Korea
- Cancer Center for Women, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Arang Kim
- Department of Genetic Counseling, College of Medicine Graduate School, Ewha Womans University, Seoul, Korea
- Department of Pediatrics Molecular Genetics, Columbia University Medical Center, New York, NY, USA
| | - Hye Sung Moon
- Cancer Center for Women, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Min-Kyung So
- Department of Genetic Counseling, College of Medicine Graduate School, Ewha Womans University, Seoul, Korea
- Department of Laboratory Medicine, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Tae-Dong Jeong
- Department of Genetic Counseling, College of Medicine Graduate School, Ewha Womans University, Seoul, Korea
- Department of Laboratory Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Kyoung Eun Lee
- Department of Hematology and Oncology, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Byung-In Moon
- Cancer Center for Women, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Korea
- Department of Surgery, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Jungwon Huh
- Department of Genetic Counseling, College of Medicine Graduate School, Ewha Womans University, Seoul, Korea
- Department of Laboratory Medicine, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Korea
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6
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Cacioppo CN, Kessler LJ, Valverde KD. Incorporating telehealth education into the genetic counseling curriculum. J Genet Couns 2023; 32:1217-1221. [PMID: 37528687 DOI: 10.1002/jgc4.1753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 06/16/2023] [Accepted: 06/29/2023] [Indexed: 08/03/2023]
Abstract
As the provision of telehealth genetic counseling (THGC) services continues to expand, it is imperative that genetic counseling students gain proficiency in telehealth service delivery. To prepare students to provide THGC services, the MSGC program at the University of Pennsylvania has included didactic sessions on THGC, THGC role plays, THGC standardized patient sessions, and THGC fieldwork experiences and clinical rotations. This article highlights best practices in THGC and guidance for Master of Science in Genetic Counseling (MSGC) programs training the next generation of genetic counselors providing THGC services.
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Affiliation(s)
- Cara N Cacioppo
- Penn Telegenetics Program, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lisa Jay Kessler
- Perelman School of Medicine, Master of Science in Genetic Counseling Program, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kathleen D Valverde
- Perelman School of Medicine, Master of Science in Genetic Counseling Program, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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7
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Lichten L, Murden R, Ali N, Bellcross C. Genetic counselors' perceptions of student supervision across service delivery models. J Genet Couns 2023; 32:1314-1324. [PMID: 37095650 DOI: 10.1002/jgc4.1711] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 02/26/2023] [Accepted: 03/13/2023] [Indexed: 04/26/2023]
Abstract
Genetic counseling (GC) services are increasingly delivered by phone or video, resulting in more telehealth student rotations. The purpose of this study was to describe genetic counselors' utilization of telehealth for student supervision and to compare how their comfort, preferences, and perception of the difficulty of selected student supervision competencies vary between phone, video, and in-person student supervision. In 2021, patient-facing genetic counselors in North America with ≥1-year GC experience who supervised ≥3 GC students in the last 3 years received an invitation via the American Board of Genetic Counseling or the Association of GC Program Directors listservs to complete a 26-item online questionnaire. There were 132 responses eligible for analysis. Demographics were fairly consistent with the National Society of Genetic Counselors Professional Status Survey. The majority of participants used more than one service delivery model to provide GC services (93%) and supervise students (89%). Six supervisory competencies related to the student-supervisor communication (Eubanks HIggins et al., 2013) were perceived to be most difficult to accomplish by phone and easiest in-person (p < 0.0001). Participants were most comfortable in-person and least comfortable by telephone for both patient care and student supervision (p < 0.001). The majority of participants predicted continued use of telehealth for patient care but preferred in-person service delivery for both patient care (66%) and student supervision (81%). Overall, these findings indicate service delivery model changes in the field have an impact on GC education and suggest that the student-supervisor relationship may be different via telehealth. Furthermore, the stronger preference for in-person patient care and student supervision, despite predicted continued telehealth utilization, points to a need for multifaceted telehealth education initiatives.
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Affiliation(s)
- Lauren Lichten
- Department of Human Genetics, School of Medicine, Emory University, Atlanta, Georgia, 30322, USA
| | - Raphiel Murden
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, 30322, USA
| | - Nadia Ali
- Department of Human Genetics, School of Medicine, Emory University, Atlanta, Georgia, 30322, USA
| | - Cecelia Bellcross
- Department of Human Genetics, School of Medicine, Emory University, Atlanta, Georgia, 30322, USA
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8
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Chu ATW, Chung CCY, Hue SPY, Chung BHY. The growing needs of genetic counselling-Feasibility in utilization of tele-genetic counselling in Asia and Hong Kong. Front Genet 2023; 14:1239817. [PMID: 37600657 PMCID: PMC10435751 DOI: 10.3389/fgene.2023.1239817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 07/20/2023] [Indexed: 08/22/2023] Open
Abstract
The need for the expansion of genomic services has been at a record time high in the past decade. As technological advancement continues to strengthen the entire genetic and genomic pipeline and clinical operational workflow, the major challenge remains to be the speed of workforce development to meet service growth. In particular, the international expansion of genetic counselling (GC) services has been a topic of interest for the past few years. GC is an emerging profession in most of Asia, and in many countries the profession of GC often refers to physicians or front-line health workers with expertise in genetics to provide GC services rather than being a specific independent profession. As genetic and genomic services, especially pre-test and post-test GC, expand globally, the need to tackle the longstanding obstacles of GC personnel shortage and funding issues must not be overlooked. There is an urgent need internationally, and especially in Asia, where GC profession is comparatively less well-established, to seek alternative approaches to meet service demand. The present review examines the global development and feasibility of tele-genetics and tele-genetic counselling (TGC), and serves as the foundation to explore a possible roadmap in Hong Kong via the Hong Kong Genome Project.
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Affiliation(s)
| | | | | | - Brian Hon Yin Chung
- Hong Kong Genome Institute, Hong Kong, Hong Kong SAR, China
- Department of Paediatrics and Adolescent Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
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9
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Koerner C, Wetzel H, Klass A, Doyle LE, Mills R. Something to chat about: An analysis of genetic counseling via asynchronous messaging following direct-to-consumer genetic testing. J Genet Couns 2023. [PMID: 36732942 DOI: 10.1002/jgc4.1683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 12/28/2022] [Accepted: 01/16/2023] [Indexed: 02/04/2023]
Abstract
Advances in technology, decreasing cost of genetic testing, and growing public interest in genetics marked by an increased uptake of genetic testing, particularly direct-to-consumer genetic testing (DTC-GT), have led to an overwhelming demand for genetic counseling services. As such, various alternative service delivery models have been proposed to increase access to genetic counseling. Some service delivery models, such as asynchronous messaging, remain unexplored in the genetic counseling literature. The purpose of this study was to assess communication during genetic counseling for DTC-GT through asynchronous messaging. A thematic analysis was conducted on 34 de-identified chat transcripts between genetic counselors and clients who underwent DTC-GT. Six categories of communication were identified and were grouped based on communication sources from either the client or the genetic counselor. Categories observed in client communication were motivations for seeking DTC testing and/or genetic counseling services, questions posed to the genetic counselor, responses provided during the session, and psychosocial aspects of the session related to the clients' mental, emotional, social, and spiritual needs. Categories of communication that emerged from the genetic counselors' communications were educational aspects of the session and counseling strategies to address concerns that are not related to educational or informational needs. Most clients had specific questions about variants detected or specific conditions. Many clients asked about appropriate subsequent steps related to additional testing or medical management. Genetic counselors discussed the limitations of DTC-GT and recommendations for clinical grade testing in almost all chat transcripts. In several chats, the genetic counselor provided advice to the client related to minimizing time sorting through likely benign results and refraining from altering medical management. Results suggest that genetic counselors are able to provide genetic information to clients and respond to their mental and emotional needs through asynchronous chat following DTC-GT. Findings from this study provide initial insight into a unique genetic counseling delivery model and reveal the informational and counseling needs of clients following DTC-GT.
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Affiliation(s)
- Cari Koerner
- Genetic Counseling Program, The University of North Carolina at Greensboro, Greensboro, North Carolina, USA.,Hereditary Cancer Program, Cone Health, Greensboro, North Carolina, USA
| | | | | | - Lauren E Doyle
- Genetic Counseling Program, The University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | - Rachel Mills
- Genetic Counseling Program, The University of North Carolina at Greensboro, Greensboro, North Carolina, USA
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10
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Dantas MAA, Da Silva JD, Tkachenko N, Paneque M. Telehealth in genetic counselling consultations: the impact of COVID-19 in a Portuguese genetic healthcare service. J Community Genet 2023; 14:91-100. [PMID: 36414926 PMCID: PMC9685011 DOI: 10.1007/s12687-022-00618-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 11/05/2022] [Indexed: 11/24/2022] Open
Abstract
The already increasing use of telemedicine in the last few years has risen significantly after the onset of the COVID-19 pandemic. With a fast implementation, it is important to understand the experience of genetic counselling patients using telehealth. To this end, we developed a study to understand the impact of the pandemic on genetics consultations, using a mixed-method approach through a questionnaire to collect the patients' opinions. The largest group included in the study was 26-45 years old (65%), and 33.6% had completed year 12 of secondary education. Due to the impact of the pandemic, we observed an increase of 84.5% in teleconsultations. The participants' satisfaction was quite significant, 67.3% felt comfortable discussing personal and family health, 53.6% were well-enlightened, and 59.1% did not find it difficult to build a doctor-patient relationship. However, 64.5% of our participants indicated using the service only for subsequent consultations but supported the idea of continuing with telemedicine in the future. Undoubtedly, this service is essential for better quality and healthcare support. The professionals involved must be increasingly trained to provide adequate genetic counselling and comfort to the patient. Training automatically influences the improvement of the service regarding the barriers encountered and consequently provides a better experience and satisfaction to the patient and their families.
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Affiliation(s)
- Mayla A. A. Dantas
- ICBAS - Instituto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Jorge Diogo Da Silva
- CGM - Centro de Genética Médica Doutor Jacinto Magalhães, Centro Hospitalar Universitário do Porto, Porto, Portugal ,ICVS - Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal ,ICVS/3B’s - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Nataliya Tkachenko
- CGM - Centro de Genética Médica Doutor Jacinto Magalhães, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Milena Paneque
- ICBAS - Instituto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, Porto, Portugal ,CGPP - Centro de Genética Preditiva e Preventiva, IBMC - Instituto de Biologia Molecular e Celular, i3S - Instituto de Investigação e Inovação EM Saúde, Universidade do Porto, Porto, Portugal
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11
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Green S, Hartzfeld D, Terry AB, Fissell K, Friedman S, Paolino N, Principe K, Sandbach J, Trzupek K, Winheld S, Malinowski J. An evidence-based practice guideline of the National Society of Genetic Counselors for telehealth genetic counseling. J Genet Couns 2023; 32:4-17. [PMID: 36054686 DOI: 10.1002/jgc4.1627] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 07/22/2022] [Accepted: 07/27/2022] [Indexed: 11/12/2022]
Abstract
There are currently no practice guidelines available for genetic counseling using telehealth modalities. This evidence-based practice guideline was developed in response to increasing use of alternative service delivery models for genetic counseling, specifically telephone and video-based genetic counseling (telehealth genetic counseling or THGC). A recent systematic evidence review (SER) compared outcomes of THGC with in-person genetic counseling and found that for the majority of studied outcomes, THGC was a non-inferior and comparable service delivery model. The SER results were used to develop this guideline. The current and anticipated future use of THGC, including the influence of the COVID-19 pandemic, provides the context for this guideline. Recommendation: The Telehealth Practice Guideline author workgroup conditionally recommends telehealth genetic counseling, either via telephone or video, as a delivery method for genetic counseling. Depending on factors unique to individual healthcare systems and provider and patient populations, THGC may be the only service delivery model available or may be utilized in addition to other service delivery models including in-person genetic counseling. The evidence shows large desirable effects, minor undesirable effects, and increased equity for patients when THGC is available. THGC may reduce or remove existing barriers to patient access to genetic counseling, such as medical conditions and/or disabilities that may affect a patient's ability to travel, inflexible work or school schedules, and lack of reliable transportation, finances, or dependent care. THGC is likely acceptable to key groups impacted by its use and is feasible to implement. Certain patient populations may require additional resources or encounter more barriers in using telemedicine services in general. For these populations, THGC can still be a valuable option if solutions are available.
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Affiliation(s)
- Sarah Green
- Institute for Digital Health and Innovation, High Risk Pregnancy Program, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Deborah Hartzfeld
- Department of Veterans Affairs, Genomic Medicine Service, Salt Lake City, Utah, USA
| | - Alissa Bovee Terry
- New York Mid-Atlantic-Caribbean Regional Genetics Network, Binghamton, New York, USA
| | | | - Sue Friedman
- Facing Our Risk of Cancer Empowered (FORCE), Tampa, Florida, USA
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Bednar EM, Harper B, Walsh MT, Rechis R, Bilbao M, Carr RL, Eppolito AL, Goedde T, Levin B, Mattie K, Morman NA, Rath K, Russ P, Siettmann JM, Warshal D, Wise E, Yobbi C, Lu KH. Implementation and outcome evaluations of a multi-site improvement program in cancer genetics. J Genet Couns 2023; 32:182-196. [PMID: 36117454 DOI: 10.1002/jgc4.1633] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 08/02/2022] [Accepted: 08/15/2022] [Indexed: 11/09/2022]
Abstract
Program evaluation can identify the successes and challenges of implementing clinical programs, which can inform future dissemination efforts. A cancer genetics improvement program, disseminated from the Lead Team's institution to five health systems (Participating Sites), was genetic counselor led, using virtual implementation facilitation to support Participating Sites' performance of quality improvement (QI) activities over several years. Program implementation and outcome evaluations were performed and included evaluation of program delivery and initial effects of the program on Participating Sites. A logic model guided evaluation of program implementation (inputs, activities, outputs, delivery/fidelity, and coverage/reach) and initial outcomes (short-term and intermediate outcomes). Data were collected from program documents and an Evaluation Survey of Participating Site team members (21 respondents), compared against the Lead Team's expectations of participation, and analyzed using descriptive statistics. All program inputs, outputs, and activities were available and delivered as expected across the five Participating Sites. The most frequently used activities and inputs were facilitation-associated meetings and meeting resources, which were rated as useful/helpful by the majority of respondents. Nearly all respondents noted improvement in short-term outcomes following participation: 82.4% reported increased awareness of clinical processes, 94.1% increased knowledge of QI methods, 100% reported increased perceived importance of QI, 94.1% increased perceived feasibility of QI, and 76.5% reported increased problem-solving skills and self-efficacy to use QI at their site. Intermediate outcomes (identifying barriers, developing interventions, improved teamwork, and capacity) were achieved following program participation as indicated by the results of the program document review and Evaluation Survey responses. Implementation challenges at Participating Sites included staffing constraints, difficulties obtaining buy-in and participation, and developing interventions over time. The multi-site improvement program was delivered and implemented with high levels of fidelity and resulted in improved short and intermediate outcomes. Future research will evaluate long-term, patient-level outcomes associated with site-specific QI interventions.
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Affiliation(s)
- Erica M Bednar
- Cancer Prevention and Control Platform, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Clinical Cancer Genetics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Blake Harper
- Cancer Prevention and Control Platform, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Impact Evaluation Core, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Michael T Walsh
- Cancer Prevention and Control Platform, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Impact Evaluation Core, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ruth Rechis
- Cancer Prevention and Control Platform, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Impact Evaluation Core, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Michelle Bilbao
- Department of Gynecologic Oncology, MD Anderson Cancer Center at Cooper University Health Care, Camden, New Jersey, USA
| | - Rebecca L Carr
- Cancer Genetics Program, Banner MD Anderson Cancer Center, Gilbert, Arizona, USA
| | - Amanda L Eppolito
- Cancer Genetics Program, Piedmont Oncology at Piedmont Healthcare, Atlanta, Georgia, USA
| | - Timothy Goedde
- Cancer Genetics Program, Community Health Network, Indianapolis, Indiana, USA
| | - Brooke Levin
- William G. Rohrer Cancer Genetics Program, MD Anderson Cancer Center at Cooper University Health Care, Camden, New Jersey, USA
| | - Kristin Mattie
- William G. Rohrer Cancer Genetics Program, MD Anderson Cancer Center at Cooper University Health Care, Camden, New Jersey, USA
| | | | - Kellie Rath
- Department of Gynecologic Oncology, OhioHealth, Columbus, Ohio, USA
| | - Pauline Russ
- Genetic Counseling Program, OhioHealth, Columbus, Ohio, USA.,Department of Surgical Oncology, OhioHealth Cancer Care, Columbus, Ohio, USA
| | - Jennifer M Siettmann
- Cancer Genetics Program, Banner MD Anderson Cancer Center, Gilbert, Arizona, USA
| | - David Warshal
- Department of Gynecologic Oncology, MD Anderson Cancer Center at Cooper University Health Care, Camden, New Jersey, USA
| | - Emaline Wise
- Genetic Counseling Program, OhioHealth, Columbus, Ohio, USA
| | - Cara Yobbi
- Cancer Genetics Program, Community Health Network, Indianapolis, Indiana, USA
| | - Karen H Lu
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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13
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Weldon CB, Trosman JR, Liang SY, Douglas MP, Scheuner MT, Kurian A, Schaa KL, Roscow B, Erwin D, Phillips KA. Genetic counselors' experience with reimbursement and patient out-of-pocket cost for multi-cancer gene panel testing for hereditary cancer syndromes. J Genet Couns 2022; 31:1394-1403. [PMID: 35900261 PMCID: PMC9722528 DOI: 10.1002/jgc4.1614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 06/15/2022] [Accepted: 06/21/2022] [Indexed: 12/14/2022]
Abstract
Multi-cancer gene panels for hereditary cancer syndromes (hereditary cancer panels, HCPs) are widely available, and some laboratories have programs that limit patients' out-of-pocket (OOP) cost share. However, little is known about practices by cancer genetic counselors for discussing and ordering an HCP and how insurance reimbursement and patient out-of-pocket share impact these practices. We conducted a survey of cancer genetic counselors based in the United States through the National Society of Genetic Counselors to assess the impact of reimbursement and patient OOP share on ordering of an HCP and hereditary cancer genetic counseling. Data analyses were conducted using chi-square and t tests. We received 135 responses (16% response rate). We found that the vast majority of respondents (94%, 127/135) ordered an HCP for patients rather than single-gene tests to assess hereditary cancer predisposition. Two-thirds of respondents reported that their institution had no protocol related to discussing HCPs with patients. Most respondents (84%, 114/135) indicated clinical indications and patients' requests as important in selecting and ordering HCPs, while 42%, 57/135, considered reimbursement and patient OOP share factors important. We found statistically significant differences in reporting of insurance as a frequently used payment method for HCPs and in-person genetic counseling (84% versus 59%, respectively, p < 0.0001). Perceived patient willingness to pay more than $100 was significantly higher for HCPs than for genetic counseling(41% versus 22%, respectively, p < 0.01). In sum, genetic counselors' widespread selection and ordering of HCPs is driven more by clinical indications and patient preferences than payment considerations. Respondents perceived that testing is more often reimbursed by insurance than genetic counseling, and patients are more willing to pay for an HCP than for genetic counseling. Policy efforts should address this incongruence in reimbursement and patient OOP share. Patient-centered communication should educate patients on the benefit of genetic counseling.
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Affiliation(s)
| | - Julia R. Trosman
- Center for Business Models in Healthcare, Glencoe, IL, USA
- Department of Clinical Pharmacy; Center for Translational and Policy Research on Personalized Medicine (TRANSPERS), University of California-San Francisco, San Francisco, CA, USA
| | - Su-Ying Liang
- Sutter Health-Palo Alto Medical Foundation Research Institute, Palo Alto, CA
| | - Michael P. Douglas
- Department of Clinical Pharmacy; Center for Translational and Policy Research on Personalized Medicine (TRANSPERS), University of California-San Francisco, San Francisco, CA, USA
| | - Maren T. Scheuner
- Departments of Medicine and Pediatrics, School of Medicine, University of California, San Francisco, CA, USA
- San Francisco VA Health Care System, San Francisco, CA, USA
| | - Allison Kurian
- Departments of Medicine and of Epidemiology and Population Health, Stanford University, Stanford, CA, USA
| | - Kendra L. Schaa
- Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Breanna Roscow
- Oncology Regional Medical Specialists Department, Myriad Genetics, Inc, Salt Lake City, UT
| | - Deanna Erwin
- Genetic Counseling Services, Color Health, Burlingame, CA
| | - Kathryn A. Phillips
- Department of Clinical Pharmacy; Center for Translational and Policy Research on Personalized Medicine (TRANSPERS), University of California-San Francisco, San Francisco, CA, USA
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA
- UCSF Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
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14
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King C, Nielsen S, Schmanski A, Abdul-Rahman O, Fishler KP. Evaluating a general pediatric/adult genetic counseling clinic in a Midwest medical center. J Genet Couns 2022; 31:1282-1289. [PMID: 35781721 PMCID: PMC10084315 DOI: 10.1002/jgc4.1603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 05/17/2022] [Accepted: 05/30/2022] [Indexed: 12/14/2022]
Abstract
In 2018, the Munroe-Meyer Institute for Genetics & Rehabilitation (MMI) at the University of Nebraska Medical Center (UNMC) in Omaha, NE created a genetic counseling clinic (GCC) to increase access to genetics services and decrease the time spent between a referral and being seen in a general genetics outpatient clinic. In the GCC, genetic counselors led patient encounters and geneticists served as advisors, rather than primary providers. We conducted a chart review of 109 patients seen in the GCC from November 1, 2018, to March 16, 2020, and obtained information regarding patient demographics, indications, and clinical recommendations as a result of the visit. Most patients seen in this clinic were female (65.1%) and aged 19 years of age or older (54.1%). The primary indications for patients in this clinic included review genetic test results (42.2%), coordination of genetic testing for a known familial variant (30.2%), and concerns for personal or family history suspicious of a genetic condition without dysmorphic features (24.8%). The average patient wait time between referral date and appointment date in the GCC was 49.8 days. The two most common clinical recommendations made by genetic counselors in the GCC were genetic testing (56.1%) and/or follow-up with specialist (26.5%). These specialists primarily included endocrinology (n = 5), neurology (n = 4), cardiology (n = 4), ophthalmology (n = 3), and audiology (n = 3). We found that the GCC model may be appropriate for patients with (1) genetic test results requiring interpretation, (2) a known familial variant or (3) genetic testing recommended by a specialist physician. Descriptions of the indications and recommendations for patients seen in this GCC provide a framework for potential implementation of a GCC in other regions across the nation.
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Affiliation(s)
- Charlie King
- Nebraska Hematology-Oncology P.C., Lincoln, Nebraska, USA
| | - Shelly Nielsen
- University of Nebraska Medical Center, Munroe-Meyer Institute for Genetics & Rehabilitation, Omaha, Nebraska, USA
| | - Andrew Schmanski
- University of Nebraska Medical Center, Munroe-Meyer Institute for Genetics & Rehabilitation, Omaha, Nebraska, USA
| | - Omar Abdul-Rahman
- University of Nebraska Medical Center, Munroe-Meyer Institute for Genetics & Rehabilitation, Omaha, Nebraska, USA
| | - Kristen P Fishler
- University of Nebraska Medical Center, Munroe-Meyer Institute for Genetics & Rehabilitation, Omaha, Nebraska, USA
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15
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Williams HE, Aiyar L, Dinulos MB, Flannery D, McClure ML, Lloyd-Puryear MA, Sanghavi K, Trotter TL, Viskochil D. Considerations for policymakers for improving health care through telegenetics: A points to consider statement of the American College of Medical Genetics and Genomics (ACMG). Genet Med 2022; 24:2211-2219. [PMID: 36040445 DOI: 10.1016/j.gim.2022.07.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 07/21/2022] [Indexed: 11/28/2022] Open
Affiliation(s)
- Heather E Williams
- Department of Pathology and Cell Biology, Columbia University, New York, NY; School of Management, Yale University, New Haven, CT
| | - Lila Aiyar
- Genomics Section, Hawaii Department of Health, Honolulu, HI
| | - Mary Beth Dinulos
- Departments of Pediatrics and Pathology, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - David Flannery
- Center for Personalized Genetic Healthcare, Cleveland Clinic, Cleveland, OH
| | | | - Michele A Lloyd-Puryear
- Retired from Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Kunal Sanghavi
- The Jackson Laboratory for Genomic Medicine, The Jackson Laboratory, Farmington, CT
| | - Tracy L Trotter
- Department of Pediatrics, John Muir Health, San Francisco, CA
| | - David Viskochil
- Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, UT
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- American College of Medical Genetics and Genomics, Bethesda, MD
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16
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Gonzalez T, Tucker K, Wakefield CE, Geelan-Small P, Macmillan S, Taylor N, Williams R. Comparing cancer genetic counselling using telegenetics with in-person and telephone appointments: Results of a partially randomised patient-preference pilot study. J Telemed Telecare 2022:1357633X221112556. [PMID: 35833346 DOI: 10.1177/1357633x221112556] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Direct-to-patient telegenetics, which uses video conferencing to connect health professionals directly to patients' devices, has been widely adopted during the pandemic. However, limited evidence currently supports its use in cancer genetic counselling. METHODS Before the pandemic, we conducted a two-arm partially randomised patient-preference pilot trial to evaluate direct-to-patient telegenetics for patients and genetic counsellors. Patients were randomised to a standard care (telephone/in-person) or direct-to-patient telegenetics appointment. Patients completed questionnaires before, during and after appointments measuring: psychological distress, perceived genetic counsellor empathy, telegenetics satisfaction and technical challenges. Genetic counsellor-reported outcomes -measured using purpose-designed questionnaires- included telegenetics satisfaction, therapeutic alliance and time for assessment. Open-ended patient and genetic counsellor questionnaire responses were synthesised using content analysis. RESULTS Fifty-six patients and seven genetic counsellors participated. Thirteen patients switched appointment type. No significant differences in distress (P = 0.84) were identified between direct-to-patient telegenetics and standard care. Perceived genetic counsellor empathy was high for all appointment types. There was no evidence of differences in reported maximum empathy scores between direct-to-patient telegenetics and standard care [telephone (P = 0.57); in-person (P = 0.44)]. Patients reported high direct-to-patient telegenetics satisfaction despite technical challenges in most appointments (65%). Genetic counsellors were satisfied with direct-to-patient telegenetics and perceived high therapeutic alliance irrespective of appointment type. No significant differences in genetic counsellor time were identified between direct-to-patient telegenetics and standard care [telephone (P > 0.90); in-person (P = 0.35)]. DISCUSSION Our results suggest that direct-to-patient telegenetics is a satisfactory service delivery model that does not appear to compromise patient-genetic counsellor relationships or increase patient distress. These findings support direct-to-patient telegenetics use in cancer genetic counselling, although larger trials are needed.
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Affiliation(s)
- Tina Gonzalez
- Prince of Wales Hereditary Cancer Centre, 376195Prince of Wales Hospital, Randwick, NSW, Australia
- Department of Clinical Genetics, 60086Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Kathy Tucker
- Prince of Wales Hereditary Cancer Centre, 376195Prince of Wales Hospital, Randwick, NSW, Australia
- Prince of Wales Clinical School, 7800UNSW Medicine and Health, UNSW Sydney, Kensington, NSW, Australia
| | - Claire E Wakefield
- School of Women's and Children's Health, 7800UNSW Medicine and Health, 7800UNSW Sydney, Kensington, NSW, Australia
- Kids Cancer Centre, 63623Sydney Children's Hospital, Randwick, NSW, Australia
| | - Peter Geelan-Small
- Stats Central, Mark Wainwright Analytical Centre, 7800UNSW Sydney, Kensington, NSW, Australia
| | - Stephanie Macmillan
- Prince of Wales Clinical School, 7800UNSW Medicine and Health, UNSW Sydney, Kensington, NSW, Australia
| | - Natalie Taylor
- School of Population Health, UNSW Medicine and Health, 7800UNSW Sydney, Kensington, NSW, Australia
| | - Rachel Williams
- Prince of Wales Hereditary Cancer Centre, 376195Prince of Wales Hospital, Randwick, NSW, Australia
- Prince of Wales Clinical School, 7800UNSW Medicine and Health, UNSW Sydney, Kensington, NSW, Australia
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17
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Allison CO, Prucka SK, Fitzgerald-Butt SM, Helm BM, Lah M, Wetherill L, Baud RE. Comparison of willingness and preference for genetic counseling via telemedicine: before vs. during the COVID-19 pandemic. J Community Genet 2022; 13:449-458. [PMID: 35794442 PMCID: PMC9261179 DOI: 10.1007/s12687-022-00598-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/25/2022] [Indexed: 11/26/2022] Open
Abstract
The COVID-19 pandemic required genetic counseling services, like most outpatient healthcare, to rapidly adopt a telemedicine model. Understanding the trends in patients’ preferences for telemedicine relative to in-person service delivery both before and after the advent of the COVID-19 pandemic may aid in navigating how best to integrate telemedicine in a post-COVID-19 era. Our study explored how respondents’ willingness to use, and preference for, telemedicine differed from before to after the onset of the COVID-19 pandemic. Respondents included patients, or their parent/guardian, seen in a general medical genetics clinic in 2018, prior to the COVID-19 pandemic, and in 2021, during the COVID-19 pandemic. Respondents were surveyed regarding their willingness to use telemedicine, preference for telemedicine relative to in-person care, and the influence of various factors. Among 69 pre-COVID-19 and 40 current-COVID-19 respondents, there was no shift in willingness to use, or preference for, telemedicine across these time periods. About half of respondents (50.6%) preferred telemedicine visits for the future. Of the 49.4% who preferred in-person visits, 79.1% were still willing to have visits via telemedicine. Predictors of these preferences included comfort with technology and prioritization of convenience of location. This study suggests that a hybrid care model, utilizing telemedicine and in-person service delivery, may be most appropriate to meet the needs of the diverse patients served. Concern for COVID-19 was not found to predict willingness or preference, suggesting that our findings may be generalizable in post-pandemic contexts.
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Affiliation(s)
- Camille O Allison
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Sandra K Prucka
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Sara M Fitzgerald-Butt
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Benjamin M Helm
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Melissa Lah
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Leah Wetherill
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Rebecca E Baud
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA.
- Indiana University Health Physicians, University Hospital, 975 W. Walnut Street, Suite 130, Indianapolis, IN, 46202, USA.
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18
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Korngiebel DM, West KM. Patient Recommendations for the Content and Design of Electronic Returns of Genetic Test Results: Interview Study Among Patients Who Accessed Their Genetic Test Results via the Internet. JMIRX MED 2022; 3:e29706. [PMID: 37725563 PMCID: PMC10414314 DOI: 10.2196/29706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 05/26/2021] [Accepted: 01/29/2022] [Indexed: 09/21/2023]
Abstract
BACKGROUND Genetic test results will be increasingly made available electronically as more patient-facing tools are developed; however, little research has been done that collects data on patient preferences for content and design before creating results templates. OBJECTIVE This study identifies patient preferences for the electronic return of genetic test results, including what considerations should be prioritized for content and design. METHODS Following user-centered design methods, 59 interviews were conducted by using semistructured protocols. The interviews explored the content and design issues of patient portals that facilitated the return of test results to patients. We interviewed patients who received electronic results for specific types of genetics tests (pharmacogenetic tests, hereditary blood disorder tests, and tests for the risk of heritable cancers) or electronically received any type of genetic or nongenetic test results. RESULTS In general, many of participants felt that there always needed to be some clinician involvement in electronic result returns and that electronic coversheets with simple summaries would be helpful for facilitating this. Coversheet summaries could accompany, but not replace, the more detailed report. Participants had specific suggestions for such results summaries, such as only reporting the information that was the most important for patients to understand, including next steps, and doing so by using clear language that is free of medical jargon. Electronic result returns should also include explicit encouragement for patients to contact health care providers about questions. Finally, many participants preferred to manage their care by using their smartphones, particularly in instances when they needed to access health information on the go. CONCLUSIONS Participants recommended that a patient-friendly front section should accompany the more detailed report and made suggestions for organization, content, and wording. Many used their smartphones regularly to access test results; therefore, health systems and patient portal software vendors should accommodate smartphone app design and web portal design concomitantly when developing platforms for returning results.
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19
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Borle K, Kopac N, Dragojlovic N, Rodriguez Llorian E, Friedman JM, Elliott AM, Lynd LD. Where is genetic medicine headed? Exploring the perspectives of Canadian genetic professionals on future trends using the Delphi method. Eur J Hum Genet 2022; 30:496-504. [PMID: 35031678 PMCID: PMC9090755 DOI: 10.1038/s41431-021-01017-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 11/22/2021] [Indexed: 12/13/2022] Open
Abstract
Driven by technological and scientific advances, the landscape of genetic medicine is rapidly changing, which complicates strategic planning and decision-making in this area. To address this uncertainty, we sought to understand genetic professionals' opinions about the future of clinical genetic and genomic services in Canada. We used the Delphi method to survey Canadian genetic professionals about their perspectives on whether scenarios about changes in service delivery and the use of genomic testing would be broadly implemented in their jurisdiction by 2030. We conducted two survey rounds; the response rates were 32% (27/84) and 67% (18/27), respectively. The most likely scenario was the universal use of noninvasive prenatal screening. The least likely scenarios involved population-based genome-wide sequencing for unaffected individuals. Overall, the scenarios perceived as most likely were those that have existing evidence about their benefit and potential medical necessity, whereas scenarios were seen as unlikely if they involved emerging technologies. Participants expected that the need for genetic healthcare services would increase by 2030 owing to changes in clinical guidelines and increased use of genome-wide sequencing. This study highlights the uncertainty in the future of genetic and genomic service provision and contributes evidence that could be used to inform strategic planning in clinical genetics.
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Affiliation(s)
- Kennedy Borle
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Nicola Kopac
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Nick Dragojlovic
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Elisabet Rodriguez Llorian
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Jan M Friedman
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | | | - Alison M Elliott
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,BC Children's Hospital Research Institute, Vancouver, BC, Canada.,BC Women's Hospital Research Institute, Vancouver, BC, Canada
| | - Larry D Lynd
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada. .,Centre for Health Evaluation and Outcomes Sciences, Providence Health Research Institute, Vancouver, BC, Canada.
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20
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Patient navigation for hereditary colorectal cancer: Design of a randomized controlled trial to determine the effectiveness of pathways to genetic counseling. Contemp Clin Trials 2022; 116:106735. [PMID: 35331945 DOI: 10.1016/j.cct.2022.106735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/28/2022] [Accepted: 03/17/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Diagnosis of Lynch and other hereditary colorectal cancer (CRC) syndromes through germline genetic testing has important implications for treatment and risk-management, yet guideline-recommended genetic counseling referral and attendance is suboptimal. METHODS Our team developed an adapted patient navigation program-Pathways to Genetic Counseling-to address multilevel barriers to genetic counseling referral and receipt. This paper describes the methods of a randomized controlled trial (RCT) testing Pathways to Genetic Counseling's effectiveness at increasing genetic counseling attendance in the University of Washington Medicine health system. We will identify CRC patients eligible for genetic counseling (diagnosed before age 50 or at any age with evidence of inherited mismatch repair deficiency) through a combination of structured electronic health record queries and manual chart review. Patients will be randomized 1:1 prior to consent and receive either care as usual (no contact) or be invited to participate in patient navigation. We will use chart review to compare rates of genetic counseling referral and attendance within six months of randomization, regardless of patients' engagement with navigation. We plan to identify and randomize 161 eligible CRC patients over a nine-month period beginning in late 2021. DISCUSSION Our pragmatic RCT design will provide real-world data on the potential for patient navigation to address longstanding care gaps in preventive genomic medicine. If effective, we hope to pilot Pathways to Genetic Counseling in additional settings with a long-term goal of improving appropriate diagnosis of hereditary CRC syndromes and subsequent cascade screening of eligible family members.
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21
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Pestoff R, Johansson P, Danielsson H, Neher M, Gunnarsson C. Rapid Implementation of Telegenetic Counseling in the COVID-19 and Swedish Healthcare Context: A Feasibility Study. FRONTIERS IN HEALTH SERVICES 2022; 2:848512. [PMID: 36925809 PMCID: PMC10012799 DOI: 10.3389/frhs.2022.848512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 05/27/2022] [Indexed: 11/13/2022]
Abstract
This study reports the process and preliminary findings of rapid implementation of telegenetic counseling in the context of Swedish healthcare and COVID-19 pandemic, from both a patient and a provider perspective. Fourty-nine patients and 6 healthcare professionals were included in this feasibility study of telegenetic counseling in a regional Department of Clinical Genetics in Sweden. Telegenetic counseling is here defined as providing genetic counseling to patients by video (n = 30) or telephone (n = 19) appointments. Four specific feasibility aspects were considered: acceptability, demand, implementation, and preliminary efficacy. Several measures were used including the Genetic Counseling Outcome Scale 24 (collected pre- and post-counseling); the Telehealth Usability Questionnaire; a short study specific evaluation and Visiba Care evaluations, all collected post-counseling. The measures were analyzed with descriptive statistics and the preliminary results show a high level of acceptance and demand, from both patients and providers. Results also indicate successful initial implementation in the regional Department of Clinical Genetics and preliminary efficacy, as shown by significant clinically important improvement in patients' empowerment levels.
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Affiliation(s)
- Rebecka Pestoff
- Centre for Rare Diseases in Southeast Region of Sweden, Linköping University, Linköping, Sweden.,Division of Community Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Department of Clinical Genetics, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Peter Johansson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Henrik Danielsson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Margit Neher
- Department of Rehabilitation, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Cecilia Gunnarsson
- Centre for Rare Diseases in Southeast Region of Sweden, Linköping University, Linköping, Sweden.,Division of Community Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Department of Clinical and Experimental Science, Linköping University, Linköping, Sweden
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22
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Ma D, Ahimaz PR, Mirocha JM, Cook L, Giordano JL, Mohan P, Cohen SA. Clinical genetic counselor experience in the adoption of telehealth in the United States and Canada during the COVID-19 pandemic. J Genet Couns 2021; 30:1214-1223. [PMID: 34757671 PMCID: PMC9528751 DOI: 10.1002/jgc4.1516] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 09/07/2021] [Accepted: 09/07/2021] [Indexed: 11/08/2022]
Abstract
The COVID-19 pandemic has significantly impacted the service delivery model (SDM) of clinical genetic counseling across the United States and Canada. A cross-sectional survey was distributed to 4,956 genetic counselors (GCs) from the American Board of Genetic Counselors and Canadian Association of Genetic Counselors mailing lists in August 2020 to assess the change in utilization of telehealth for clinical genetic counseling during the COVID-19 pandemic compared with prior to the pandemic. Data from 411 eligible clinical genetic counselors on GC attitudes and their experiences prior to and during the pandemic were collected and analyzed to explore the change in SDM, change in appointment characteristics, change in billing practices, GC perceived benefits and limitations of telehealth, and prediction of future trends in SDM in the post-pandemic era. The study showed the overall utilization of audiovisual and telephone encounters increased by 43.4% and 26.2%, respectively. The majority of respondents who provided audiovisual and telephone encounters reported increased patient volume compared with prior to the pandemic, with an average increase of 79.4% and 42.8%, respectively. There was an increase of 69.4% of GCs rendering genetic services from home offices. The percentage of participants who billed for telehealth services increased from 45.7% before the pandemic to 80.3% during the pandemic. The top GC perceived benefits of telehealth included safety for high-risk COVID patients (95.2%) and saved commute time for patients (94.7%). The top GC perceived limitations of telehealth included difficulty to conduct physician evaluation/coordinating with healthcare providers (HCP) (73.7%) and difficulty addressing non-English speaking patients (68.5%). Overall, 89.6% of GCs were satisfied with telehealth; however, 55.3% reported uncertainty whether the newly adopted SDM would continue after the pandemic subsides. Results from this study demonstrate the rapid adoption of telehealth for clinical genetic counseling services as a result of the COVID-19 pandemic, an increase in billing for these services, and support the feasibility of telehealth for genetic counseling as a longer term solution to reach patients who are geographically distant.
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Affiliation(s)
- Daria Ma
- Cedars Sinai Medical Center, Smidt Heart Institute, Los Angeles, California, USA
| | - Priyanka R Ahimaz
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA
| | - James M Mirocha
- Cedars-Sinai Research Institute and Clinical & Translational Science Institute (CTSI), Los Angeles, California, USA
| | - Lola Cook
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Jessica L Giordano
- Department of OBGYN, Columbia University Irving Medical Center, New York, New York, USA
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23
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Bernstein-Molho R, Evron E, Yerushalmi R, Paluch-Shimon S. Genetic testing in patients with triple-negative or hereditary breast cancer. Curr Opin Oncol 2021; 33:584-590. [PMID: 34474437 DOI: 10.1097/cco.0000000000000784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW In recent years there has been a dramatic evolution in the clinical utility of genetic testing with expanding therapeutic implications for individuals with breast cancer who harbor a germline mutation in BRCA1/2. As these therapeutic opportunities expand and evolve, this requires the clinical and research community to rethink the approach to genetic testing for individuals with breast cancer. RECENT FINDINGS Genetic testing is evolving from traditional testing models based on pretest counseling with the aim of identifying hereditary and individual risk for purposes of screening and risk reduction to contemporary models that utilize technology to improve accessibility and oncology led mainstreaming of testing where the oncologist refers for genetic testing, discloses the results and formal counseling occurs later in the process than in traditional models. The cost and accessibility to multigene panel testing have resulted in broad uptake despite the fact that clinical utility and appropriate interpretation of results are not yet well established. Furthermore, somatic testing for genomic alterations may also yield results beyond the disease with detection of germline mutations impacting the individual and their family more broadly than anticipated. SUMMARY With the establishment of poly (adenosine diphosphate-ribose) polymerase inhibitors as part of the treatment armamentarium for early and advanced breast cancer, paradigms, algorithms, and resources for genetic testing need to rapidly change in order to adapt to the evolution of germline mutations from hereditary and individual risk predictors to predictive therapeutic biomarkers.
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Affiliation(s)
- Rinat Bernstein-Molho
- Susanne Levy Gertner Oncogenetics Unit, The Danek Gertner Institute of Human Genetics, Chaim Sheba Medical Center, Tel-Hashomer.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv
| | - Ella Evron
- Department of Oncology, Kaplan Medical Center, Rehovot.,Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Rinat Yerushalmi
- Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, Petah Tikva.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv
| | - Shani Paluch-Shimon
- Sharett Institute of Oncology, Hadassah University Hospital, Jerusalem.,Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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24
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Matsukawa M, Torishima M, Satoh C, Honda S, Kosugi S. Japanese women's reasons for accompaniment status to hereditary breast and ovarian cancer-focused genetic counseling. J Genet Couns 2021; 31:497-509. [PMID: 34661949 DOI: 10.1002/jgc4.1519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 09/10/2021] [Accepted: 09/12/2021] [Indexed: 11/08/2022]
Abstract
Genetic counselors routinely assess and understand clients' needs at the beginning of a session. Attending a genetic counseling session with or without companions is an objective sign that genetic counselors can easily notice. This study focused on clients' reasons for their accompaniment status for genetic counseling, which we categorize into attending with or without a companion(s). A questionnaire survey and interviews were conducted using snowball sampling, starting with the chief executive officer (CEO) of the Japanese hereditary breast and ovarian cancer (HBOC) support group. Of 32 participants, 19 continued with an in-depth interview after answering the questionnaire. Five themes were identified from the interview: (1) personal confidence, (2) decision-making style, (3) family members' habits and time availability, (4) considerations and conflicts with family members, and (5) healthcare provider's suggestion. Our data suggested that the clients expected their companion(s) to play certain roles. This indicates that the reasons of accompaniment status will be helpful for genetic counselors to understand both clients' and their families' motivations, personalities, habits, and psychosocial backgrounds. In a high-context culture such as that of Japan, accompaniment status may be a helpful sign to understand clients' true worries. In addition, some companions may be future clients in genetic counseling, due to the genetic nature of the disease. In conclusion, our study indicated that it is important for genetic counselors to record accompaniment status before the initial genetic counseling and to pay attention to its reasons at the beginning of the session, which may lead them to understand the client's psychosocial background to facilitate better client-centered genetic counseling.
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Affiliation(s)
- Manami Matsukawa
- Department of Medical Genetics and Medical Ethics, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Clinical Genetics, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Masako Torishima
- Department of Genomic Medicine, Kyoto University School of Public Health, Kyoto, Japan.,Department of Clinical Genetics Units, Kyoto University Hospital, Kyoto, Japan
| | - Chika Satoh
- Department of Obstetrics and Gynecology, Kansai Medical University, Osaka, Japan
| | - Sayaka Honda
- Department of Clinical Genetics Units, Kyoto University Hospital, Kyoto, Japan
| | - Shinji Kosugi
- Department of Medical Genetics and Medical Ethics, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Clinical Genetics Units, Kyoto University Hospital, Kyoto, Japan
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25
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Rezich BMZ, Malone JA, Reiser G, Zimmerman HH, Blase TL, Fishler KP. Telehealth genetic services during the COVID-19 Pandemic: Implementation and patient experiences across multiple specialties in Nebraska. J Genet Couns 2021; 30:1233-1243. [PMID: 34617357 DOI: 10.1002/jgc4.1507] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 09/02/2021] [Accepted: 09/03/2021] [Indexed: 11/08/2022]
Abstract
The COVID-19 pandemic has altered the delivery of genetics services. In response to the pandemic, our genetics department offered telehealth visits to all outpatients, regardless of their physical proximity to Omaha, Nebraska. Traditionally, our department did not offer telehealth visits to patient's homes or to patients who lived in close proximity to a genetics clinic. Therefore, we designed a survey to gain insight into the patient experience with remote genetic counseling appointments during the pandemic. Any patient referred to see a genetics provider in pediatrics, prenatal, adult, or cancer between March 16, 2020 and October 28, 2020 was eligible for the study. The survey included both quantitative and qualitative measures to assess patient demographics, patient experience, stressors during the COVID-19 pandemic, and anxiety and depression. We hypothesized that patients would report they received quality care by telehealth despite the presence of COVID-19-related stressors or anxiety/depression. From the 143 survey participants, 80% had their first telehealth appointment during the pandemic. The vast majority (96%) reported that they felt like they received quality care by telehealth. Additionally, more than 93% of participants strongly or somewhat agreed that their genetic providers were attentive to their emotional needs, medical needs, and privacy. Since March 2020, participants reported experiencing several COVID-19-related stressors including fear of illness (86%), feelings of isolation (45%), and safety concerns (33%). Relatively low levels of depressive and anxiety symptoms were recorded using the HADS questionnaire. Despite the prevalence of COVID-19 stressors, depression, and/or anxiety, our participants felt they received quality care via telehealth. In fact, 51% agree that they prefer to receive future genetics services virtually. These results suggest the value of telehealth as an alternative service delivery model, even for local patients, and should be offered for future appointments, beyond the COVID-19 pandemic.
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Affiliation(s)
- Brianna M Z Rezich
- Munroe-Meyer Institute for Genetics and Rehabilitation, University of Nebraska Medical Center, Omaha, NE, USA
| | - Jaime A Malone
- Munroe-Meyer Institute for Genetics and Rehabilitation, University of Nebraska Medical Center, Omaha, NE, USA
| | - Gwen Reiser
- Munroe-Meyer Institute for Genetics and Rehabilitation, University of Nebraska Medical Center, Omaha, NE, USA
| | - Holly H Zimmerman
- College of Allied Health Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | - Terri L Blase
- Munroe-Meyer Institute for Genetics and Rehabilitation, University of Nebraska Medical Center, Omaha, NE, USA
| | - Kristen P Fishler
- Munroe-Meyer Institute for Genetics and Rehabilitation, University of Nebraska Medical Center, Omaha, NE, USA
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26
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Wessels TM, Düsterwald G, Barlow R, Cameron-Mackintosh S, Diedericks A, Francois S, Laing N, Pretorius W, Scholtz K, Vorster N. Genetic counseling experiences at the University of Cape Town during COVID-19. J Genet Couns 2021; 30:1298-1309. [PMID: 34585458 DOI: 10.1002/jgc4.1520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 09/07/2021] [Accepted: 09/11/2021] [Indexed: 11/08/2022]
Abstract
Soon after the first COVID-19 case was reported in December 2019 in Wuhan, China, South Africa announced a national lockdown in an attempt to curb the spread of the disease. Under national lockdown, businesses were closed, learning institutions moved to emergency remote teaching (ERT), and hospitals reduced their patient loads. De-escalation of clinical services at Groote Schuur and Red Cross War Memorial Children's Hospitals affected Genetic Counseling Services and resulted in a decrease in in-person and an increase in telecounseling sessions. ERT, offered by the University of Cape Town, affected the teaching of Genetic Counseling students, and other methods of training had to be found to compensate for the lack of patient contact. In this paper, we present our Genetic Counseling team's experiences of learning and clinical services during the COVID-19 pandemic in South Africa. The team met online as a group in November 2020 to discuss their experiences. The discussion was recorded and transcribed, and topics that arose during the discussion were identified. The pandemic and the accompanying lock down, which forced trainees to move back home, resulted in great uncertainty. The trainees found ERT on an online platform, including simulated cases, very helpful, but they lost the confidence to work with real patients. Telecounseling became the predominant form of service delivery and was experienced as positive when video sessions were possible. The telephone service for advanced maternal age counseling was problematic due to unreliable networks. The biggest loss for the GCs was the feeling of disconnection from peers, supervisors, and patients. The experiences highlighted positive and negative aspects as well as specific challenges faced in South Africa. Lessons learnt from the COVID-19 pandemic will be used in future to improve training of GCs and to enhance service delivery.
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Affiliation(s)
- Tina-Marié Wessels
- Division Human Genetics, Department of Pathology, Faculty Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Gillian Düsterwald
- Division Human Genetics, Department of Pathology, Faculty Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Robyn Barlow
- Division Human Genetics, Department of Pathology, Faculty Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Sinead Cameron-Mackintosh
- Division Human Genetics, Department of Pathology, Faculty Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Angelique Diedericks
- Division Human Genetics, Department of Pathology, Faculty Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Sydney Francois
- Division Human Genetics, Department of Pathology, Faculty Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Nakita Laing
- Division Human Genetics, Department of Pathology, Faculty Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Willem Pretorius
- Division Human Genetics, Department of Pathology, Faculty Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Kathrine Scholtz
- Division Human Genetics, Department of Pathology, Faculty Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Nina Vorster
- Division Human Genetics, Department of Pathology, Faculty Health Sciences, University of Cape Town, Cape Town, South Africa
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27
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Enns EA, Wainstein T, Dragojlovic N, Kopac N, Lynd LD, Elliott AM. Far and wide: Exploring provider utilization of remote service provision for genome-wide sequencing in Canada. Mol Genet Genomic Med 2021; 9:e1784. [PMID: 34532994 PMCID: PMC8580085 DOI: 10.1002/mgg3.1784] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 07/31/2021] [Accepted: 08/12/2021] [Indexed: 11/22/2022] Open
Abstract
Background In Canada, funding for genome‐wide sequencing (GWS; exome and whole genome) is provincially regulated. We characterized the uptake of GWS by genetics health professionals (GHPs) across Canada and describe how they use remote technologies for patient access to GWS and genomic counseling. Methods We distributed a survey to 574 Canadian GHPs addressing: GWS use, remote technologies (e.g., telephone, videoconferencing) for GWS and provider opinions regarding these technologies. Data were summarized using descriptive statistics. Associations between variables were evaluated using Chi‐square and Fisher's Exact tests for categorical data, and t‐tests or Mann–Whitney U tests for continuous data. Results Of 116 GHPs, 50% reported using GWS in the last year and 57% of GWS users reported using remote technologies. Clinical geneticists who did not use GWS reported lack of provincial funding as the principal reason. Remote technologies were most commonly used for informed consent and results, and rarely used for initial consultations. Average wait times for a GWS appointment were shorter for remote appointments (mean 44.2 (SD 40.2) weeks) than for in‐person (mean 58.2 (SD 42.9), p = 0.036). Conclusion The use of GWS varied across Canada, professional designation, and discipline. Funding remains a barrier to GWS access. Remote technologies increase patient access with reduced wait times.
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Affiliation(s)
- Emily A Enns
- Department of Human Genetics, McGill University, Montreal, Quebec, Canada
| | - Tasha Wainstein
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nick Dragojlovic
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nicola Kopac
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Larry D Lynd
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Health Evaluation and Outcomes Sciences, Providence Health Research Institute, Vancouver, British Columbia, Canada
| | - Alison M Elliott
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada.,BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,Women's Health Research Institute, Vancouver, British Columbia, Canada
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28
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Danylchuk NR, Cook L, Shane-Carson KP, Cacioppo CN, Hardy MW, Nusbaum R, Steelman SC, Malinowski J. Telehealth for genetic counseling: A systematic evidence review. J Genet Couns 2021; 30:1361-1378. [PMID: 34355839 DOI: 10.1002/jgc4.1481] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 06/28/2021] [Accepted: 06/29/2021] [Indexed: 12/25/2022]
Abstract
Telehealth options, such as telephone counseling or videoconferencing, for service delivery in genetic counseling are becoming more widely accepted. However, until now, there has not been a systematic review of the literature focused specifically on genetic counseling outcomes for telehealth. We performed a systematic evidence review to compare telehealth genetic counseling (THGC), including videoconferencing and telephone counseling, across specialties to in-person genetic counseling (IPGC) for a range of outcomes specific to patient and provider experiences and access to care. Several biomedical databases were queried up to January 11, 2021, to identify original research evaluating THGC. Through this search, 42 articles met the inclusion criteria including 13 randomized controlled trials and 29 non-randomized observational studies encompassing 13,901 patients. Most included studies focused only on cancer genetic counseling; however, adult, pediatric, and prenatal specialties were also represented. The majority of studies evaluated patient and/or access to care outcomes. Though most studies reported high patient satisfaction with THGC, as well as comparable rates of trust and rapport, confidence in privacy, health behavior changes, and psychosocial outcomes, few represented diverse populations. Data of provider experiences were limited and varied with more disadvantages noted compared with patient experiences, particularly in studies involving telephone genetic counseling. Studies consistently reported a decrease in the patients' costs and time required for travel when patients are seen via THGC compared to IPGC with a similar reduction in costs to the health system. Overall, results from our evidence synthesis suggest THGC is non-inferior or comparable to IPGC across many domains, even considering that many of the studies included in this review were conducted with telehealth systems, notably videoconferencing, that were less robust and reliable than what is available today. There are notable limitations within this body of literature, leading to potential uncertainty in the generalizability of our analysis. We outline several recommendations for future studies.
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Affiliation(s)
- Noelle R Danylchuk
- Department of Genetic Counseling, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Lola Cook
- Department of Medical & Molecular Genetics, Indiana U School of Medicine, Indianapolis, Indiana, USA
| | - Kate P Shane-Carson
- Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Cara N Cacioppo
- Penn Telegenetics Program, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Rachel Nusbaum
- University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Susan C Steelman
- University of Arkansas for Medical Sciences Library, Little Rock, Arkansas, USA
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29
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Uhlmann WR, McKeon AJ, Wang C. Genetic counseling, virtual visits, and equity in the era of COVID-19 and beyond. J Genet Couns 2021; 30:1038-1045. [PMID: 34291525 PMCID: PMC8426877 DOI: 10.1002/jgc4.1469] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 06/18/2021] [Accepted: 06/20/2021] [Indexed: 11/30/2022]
Abstract
Overnight, as a result of the COVID‐19 pandemic, telehealth rapidly transitioned from limited application to widespread implementation. The field of genetic counseling was well positioned to make this transition to virtual care since there is generally less of a need for patients to be seen in‐person for physical exams or urgent care. Going forward, virtual visits will presumably become a mainstay in the provision of genetic services and it is anticipated that clinics will adopt “hybrid” models with both in‐person and virtual visit options. This commentary highlights the successes and challenges in the rapid implementation of virtual visits, focusing on who has benefited versus who has been challenged or left behind. We also discuss genetic testing considerations, including the additional steps required for patients and clinicians when testing is ordered outside of the clinical setting, which can result in delays or a lack of testing altogether. Future research considerations are presented to address the needs among the most vulnerable and help ensure equitable access and benefit.
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Affiliation(s)
- Wendy R Uhlmann
- Division of Genetic Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.,Department of Human Genetics, University of Michigan, Ann Arbor, Michigan, USA.,Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Andrew J McKeon
- Department of Human Genetics, University of Michigan, Ann Arbor, Michigan, USA
| | - Catharine Wang
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts, USA
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30
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Dratch L, Paul RA, Baldwin A, Brzozowski M, Gonzalez-Alegre P, Tropea TF, Raper A, Bardakjian T. Transitioning to telegenetics in the COVID-19 era: Patient satisfaction with remote genetic counseling in adult neurology. J Genet Couns 2021; 30:974-983. [PMID: 34265143 PMCID: PMC8427091 DOI: 10.1002/jgc4.1470] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 06/17/2021] [Accepted: 06/20/2021] [Indexed: 01/13/2023]
Abstract
The COVID-19 pandemic rapidly changed genetic counseling services across the United States. At the University of Pennsylvania (UPenn), a large academic hospital in an urban setting, nearly all genetic counseling (GC) visits for adult-onset disorders within the Department of Neurology were conducted via secure videoconferencing (telegenetics) or telephone between March and December 2020. Although telemedicine services have been steadily emerging, many clinical programs, including the neurogenetics program at UPenn, had not built infrastructure or widely utilized these services prior to the pandemic. Thus, little is known about patient attitudes toward receiving clinical GC services remotely. From May 18 to October 18, 2020, all individuals seen remotely for GC in adult neurology via telephone or telegenetics were surveyed about their satisfaction with telehealth GC (N = 142), with a response rate of 42% (N = 60/142). Telephone and telegenetics services were referred to as 'telehealth' in the surveys to capture patient perspectives on all remote GC services, though the majority (N = 49/60) of these visits were completed via telegenetics. Surveys included the modified telehealth usability questionnaire (MTUQ), genetic counseling satisfaction scale (GCSS), and novel questions about future telehealth use. Preliminary results suggest that patients were satisfied with receiving remote GC services in adult neurology, with most participants strongly agreeing to all items about satisfaction with telehealth. Just 2% of participants preferred only in-person visits in the future, but every participant was willing to consider using telehealth for future visits if their genetic counselor felt it was appropriate. Most participants preferred a hybrid model (73%), and some (25%) preferred only telehealth for future visits. Additionally, we found no differences in satisfaction with remote services based on visit type (initial vs. results disclosure) nor age. We conclude that remote GC is an acceptable method for the provision of services in adult neurology that is well-received by patients.
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Affiliation(s)
- Laynie Dratch
- Department of Neurology, Neurogenetics Translational Center of Excellence, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rachel A Paul
- Department of Neurology, Neurogenetics Translational Center of Excellence, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Aaron Baldwin
- Department of Neurology, Neurogenetics Translational Center of Excellence, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Morgan Brzozowski
- Department of Neurology, Neurogenetics Translational Center of Excellence, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Pedro Gonzalez-Alegre
- Department of Neurology, Neurogenetics Translational Center of Excellence, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Thomas F Tropea
- Department of Neurology, Neurogenetics Translational Center of Excellence, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Anna Raper
- Department of Neurology, Neurogenetics Translational Center of Excellence, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Tanya Bardakjian
- Department of Neurology, Neurogenetics Translational Center of Excellence, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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31
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Uptake and acceptability of a mainstreaming model of hereditary cancer multigene panel testing among patients with ovarian, pancreatic, and prostate cancer. Genet Med 2021; 23:2105-2113. [PMID: 34257420 PMCID: PMC8556289 DOI: 10.1038/s41436-021-01262-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 06/14/2021] [Accepted: 06/15/2021] [Indexed: 02/07/2023] Open
Abstract
Purpose: To address demands for timely germline information to guide treatments, we evaluated experiences of patients with ovarian, pancreatic, and prostate cancer with a mainstreaming genetic testing model wherein multigene panel testing was ordered by oncologists with standardized pre-test patient education, and genetic counselors delivered results and post-test genetic counseling via telephone. Methods: Among 1203 eligible patients, we conducted a prospective single-arm study to examine patient uptake and acceptability (via self-report surveys at baseline and three-weeks and three-months following result return) of this mainstreaming model. Results: Only 10% of eligible patients declined participation. Among 1054 tested participants, 10% had pathogenic variants (PV), 16% had variants of uncertain significance (VUS), and 74% had no variant identified (NV). Participants reported high initial acceptability, including high satisfaction with their testing decision. Variability over time in several outcomes existed for participants with PV or NV: Those with NV experienced a temporary increase in depression (pTime<0.001; pTime2<0.001), and those with PV experienced a small increase in genetic testing distress (p=0.03). Findings suggested that result type, sex, and cancer type were also associated with outcomes including clinical depression and uncertainty. Conclusion: This mainstreaming model may offer a feasible approach for extending access to germline genetic information.
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32
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Allain DC, Randall Armel S, Carmany EP, Creswick H, McBrien SB, Reed EK, Williams JL. The Accreditation Council for Genetic Counseling's response to COVID-19 impact on genetic counseling programs. J Genet Couns 2021; 30:1046-1056. [PMID: 34224607 PMCID: PMC8426665 DOI: 10.1002/jgc4.1456] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 05/06/2021] [Accepted: 05/22/2021] [Indexed: 11/22/2022]
Affiliation(s)
- Dawn C Allain
- Division of Human Genetics, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Susan Randall Armel
- Department of Medicine, Familial Cancer Clinic, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Erin P Carmany
- Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, MI, USA
| | | | - Sarah B McBrien
- College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NB, USA
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33
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Mann C, Goodhue B, Guillard A, Slamon J, Newman R, Zhao Z, Ding T, Petrelli G, Dudek M. The COVID-19 pandemic and reproductive genetic counseling: Changes in access and service delivery at an academic medical center in the United States. J Genet Couns 2021; 30:958-968. [PMID: 34224635 PMCID: PMC8426661 DOI: 10.1002/jgc4.1462] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 06/01/2021] [Accepted: 06/06/2021] [Indexed: 11/11/2022]
Abstract
The COVID‐19 pandemic widely disrupted the delivery of healthcare services, including genetic counseling. To ensure continuity of care, the reproductive genetic counselors at a large academic medical center in the United States rapidly transitioned their practice from 90% in‐person patient consultations to a predominantly telehealth model. The present study describes this transition in regard to patient access to genetic counseling and genetic screening. A chart review of patients seen by the reproductive genetic counselors from January 2020 to August 2020 was completed. The time frame included the three months prior to the COVID‐19 pandemic and the first five months during COVID‐19. Patient demographics and clinical and appointment data were compared between the pre‐COVID‐19 and during‐COVID‐19 timeframes. Overall, 88.6% of patients were seen via telehealth during COVID‐19 and there was no significant difference based upon patient age (p = .20), indication for appointment (p = .06), or gestational age (p = .06). However, non‐English speaking patients were more often seen in‐person than by telehealth (p < .001), and more patients residing farther from the clinic were seen via telehealth (p = .004). During‐COVID‐19 results for prenatal cell‐free DNA screening and expanded carrier screening were delayed (p < .001). Additionally, after consenting to screening, patients seen during COVID‐19 were more likely to not complete a sample collection for their intended screening when compared to those seen pre‐COVID‐19 (OR = 6.15, 95% CI = 1.43–26.70, p = .015). Overall, this study supports that access to genetic counseling services and genetic screening can be maintained during a global pandemic like COVID‐19. Genetic counselors are well‐equipped to pivot swiftly during challenging times; however, they must continue to work to address other barriers to accessing genetic services, especially for non‐English speaking populations. Future studies are needed to pose solutions to the obstacles confronted in this service delivery model during a global pandemic.
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Affiliation(s)
- Caitlin Mann
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Brighton Goodhue
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Arianna Guillard
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jill Slamon
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Randa Newman
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Zhiguo Zhao
- Department of Biostatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Tan Ding
- Department of Biostatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Gianna Petrelli
- Master's in Genetic Counseling Program, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Martha Dudek
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN, USA
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Chandrasekar T, Kelly WK, Gomella LG. Overview of Prostate Cancer Genetic Testing. Urol Clin North Am 2021; 48:279-282. [PMID: 34210484 DOI: 10.1016/j.ucl.2021.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Thenappan Chandrasekar
- Department of Urology, Sidney Kimmel Cancer Center, Thomas Jefferson University, 1025 Walnut Street, Suite 1100, Philadelphia, PA 19107, USA.
| | - William K Kelly
- Medical Oncology and Urology, Division of Solid Tumor Oncology, Department of Medical Oncology, Sidney Kimmel Medical College, Thomas Jefferson University, Sidney Kimmel Cancer Center, 1025 Walnut Street, Suite 700, Philadelphia, PA 19107, USA
| | - Leonard G Gomella
- Department of Urology, Thomas Jefferson University and Hospital, Sidney Kimmel Cancer Center, Thomas Jefferson University, 1025 Walnut Street, Suite 1100, Philadelphia, PA 19107, USA. https://twitter.com/LeonardGomella
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Donohue KE, Gooch C, Katz A, Wakelee J, Slavotinek A, Korf BR. Pitfalls and challenges in genetic test interpretation: An exploration of genetic professionals experience with interpretation of results. Clin Genet 2021; 99:638-649. [PMID: 33818754 DOI: 10.1111/cge.13917] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/11/2020] [Accepted: 01/04/2021] [Indexed: 12/17/2022]
Abstract
The interpretation of genetic testing results is subject to error. This observational study illustrates examples of pitfalls and challenges in interpretation of genetic testing results as reported by genetics professionals. We surveyed genetics professionals to describe interpretation challenges, the types of variants that were involved, and the reported clinical impact of misconception of a test result. Case studies were then collected from a select group to further explore potential causes of misunderstanding. A total of 83% of survey respondents were aware of at least one instance of genetic test misinterpretation. Both professionals with and without formal training in genetics were challenged by test reports, and variants of unknown significance were most frequently involved. Case submissions revealed that interpretation pitfalls extend beyond variant classification analyses. Inferred challenges in case submissions include lack of genetic counseling, unclear wording of reports, and suboptimal communication among providers. Respondents and case submitters noted that incorrect interpretation can trigger unnecessary follow-up tests and improperly alter clinical management. Further research is needed to validate and quantify large-scale data regarding challenges of genetic results interpretation.
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Affiliation(s)
- Katherine E Donohue
- Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Catherine Gooch
- Department of Genetics, University of Alabama at Birmingham, Birmingham, Alabama, USA.,Pediatrics, Division of Genetics and Genomic Medicine, Washington University at St Louis School of Medicine, St. Louis, MO, USA
| | - Alexander Katz
- Medical Genomics and Metabolic Genetics Branch, National Human Genome Research Institute, NIH, Bethesda, Maryland, USA
| | - Jessica Wakelee
- Center for the Study of Community Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Anne Slavotinek
- Division of Genetics, Department of Pediatrics, University of California, San Francisco, California, USA
| | - Bruce R Korf
- Department of Genetics, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Abstract
PURPOSE OF REVIEW The aim of the article is to provide an update on recent evidence for utilization and challenges of implementation of telegenetics in the clinical practice. RECENT FINDINGS Implementation of telegenetics in health systems is still limited, below 10%, somewhat higher for cancer genetic counseling. Nevertheless, telegenetic services have been shown useful in the COVID pandemic. Key factors for efficient implementation include a patient-centered approach, engaging the major stakeholders, and incorporating telegenetics into existing health policies. Main barriers remain: limitations to billing and reimbursement, licensure, proper equipment and technical issues, engagement of referring providers and patients, coordination of services with local health providers, and lack of decision-making power. Further rigorous studies are needed to investigate the outcomes of telegenetics and to motivate health policies for change. SUMMARY Despite continuous evidence of the benefits of telegenetics, its use in health systems remains limited. Further, larger, prospective, randomized, long-term studies are needed to address the outcomes.Enabling factors contributing to the implementation of telegenetics are patient-centeredness, the involvement of major stakeholders, and aligning telegenetics with the existing national health policies.
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Bergstrom KL, Brander TE, Breen KE, Naik H. Experiences from the epicenter: Professional impact of the COVID-19 pandemic on genetic counselors in New York. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2020; 187:28-36. [PMID: 33225573 PMCID: PMC7753596 DOI: 10.1002/ajmg.c.31855] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 10/26/2020] [Accepted: 10/29/2020] [Indexed: 12/11/2022]
Abstract
The COVID-19 pandemic disrupted the delivery of healthcare services, including genetic counseling. This study assessed the professional impact of the pandemic on genetic counselors (GCs) and evaluated how genetics service delivery models changed in New York State (NYS). One hundred sixty-five NYS GCs participated in an anonymous survey. Clinic structure, telegenetics (video and/or telephone consultations) use and acceptability, and professional practices before and during the pandemic were compared. The most frequently reported consultation type shifted from in-person only (49%) before the pandemic to telegenetics only (39%) during. Most were satisfied with video (93.1%) and telephone (81.4%) telegenetics. Additionally, 93.5% of participants expressed a desire to continue using telegenetics after the pandemic resolves. Common obstacles included difficulties coordinating sample collection (60.2%) and obtaining written consent for testing (57.6%). Billing methods for consultations during the pandemic did not change significantly. Participants were asked about NYS's lack of licensure, which restricts billing options. Most felt that genetic counseling licensure would benefit the profession (92.6%), the public (88.5%), and their institution/company (74.5%). This study provides insight into the effects of the rapid adoption of telegenetics and can guide future discussions about best practices for its use even after the health crisis resolves.
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Affiliation(s)
| | - Tehilla E Brander
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Kelsey E Breen
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - Hetanshi Naik
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
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Anderson K, Terry SF. Please Wait for the Host to Start This Meeting: A Push for H.R. 3235 Amid COVID-19. Genet Test Mol Biomarkers 2020; 24:689-691. [DOI: 10.1089/gtmb.2020.29058.sjt] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Affiliation(s)
- Katherine Anderson
- Genetic Alliance, Washington, District of Columbia, USA
- Colgate University, Hamilton, New York, USA
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