Genetic counseling in the time of COVID-19: The Philippine experience with telegenetics

Cancer genetic counseling via telegenetics and telephone: A qualitative study exploring the experience of patients and genetic counselors in an Australian cancer genetics context

The demand for direct-to-patient (DTP) telegenetics (genetics services delivered via videoconferencing) in genetic counseling practice has rapidly increased, particularly since the COVID-19 pandemic. Recent telegenetics literature is mostly quantitative and not in the Australian context. A qualitative interview study was conducted to address this gap. This research investigated the experiences of patients and genetic counselors (GCs), enrolled in a randomized controlled trial, using telegenetics and telephone for cancer genetic counseling appointments. Twenty-eight semi-structured interviews with patients (n = 22) and GCs (n = 6) were conducted following patient randomization to either a telephone or telegenetics genetic counseling appointment. The interviews explored participant's experiences of telegenetics and compared DTP telegenetics with telephone and in-person delivery. Codebook thematic analysis was used to develop topic summaries from the data. Patient and GC participants noted positive experiences of telegenetics; with key benefits reported as reduced travel time, time and cost saving, ease, convenience, efficiency, and comfortability. Technical issues and privacy concerns were highlighted as potential disadvantages of telegenetics. All but one patient felt sufficiently emotionally supported while using telegenetics. Telegenetics has both benefits and limitations; however, generally, this cohort found telegenetics to be a suitable and acceptable mode of delivery for genetic counseling with many advantages over in-person or telephone appointments. Further studies should be conducted to provide evidence for the long-term implementation of telegenetics, regardless of any future COVID-19 pandemic lockdown restrictions.

Landscape of genetic counseling in the Philippines

In this paper, we report on the professional development of genetic counselors in the Philippines as we discuss the status of genetic counseling training and research, along with the roles and scope of practice of genetic counselors. The development of a master's level training program for non-physician genetic counselors in the Philippines initiated in 2011 was in response to the increasing demand for genetic counseling services. There are currently 18 locally trained genetic counselors who are practicing in various fields including newborn screening, pediatrics, cancer, prenatal and preconception, neurology, and research. Despite the success of the genetic counseling training program, various professional challenges hinder maximizing the impact of genetic counselors in the health system. The challenges discussed in this paper include the limited number of genetic counselors, the lack of government positions officially recognizing the 'genetic counselor' title, and the absence of a regulatory framework. These issues require thorough discussion with appropriate government agencies and collaboration with other healthcare professional organizations with the ultimate goal of ensuring quality genetic counseling services nationwide.

Integrating Genetic Services in the Philippine Public Health Delivery System: The Value of Networks

The delivery of genetic services in developing countries is faced with significant challenges, despite medical and technological advances globally. The Philippines, being an archipelago, faces even more challenges, with significant disparities in access to healthcare, and tertiary medical centers and specialists being concentrated in the major cities. The utilization of different networks for the integration of genetic services in the existing public health delivery system has been valuable. Using the well-established network of the national newborn screening program, genetic services have been successfully integrated into the delivery of healthcare, even at the grassroot level. Equitable access to healthcare, including genetic services, was highlighted and supported by the enactment of the Rare Disease Law in 2016. The support of the academe to assure the sustainability of services was evident in the establishment of a genetic counseling program to augment the work of a handful of clinical geneticists. Professional societies and support groups have been instrumental in identifying genetic conditions to be prioritized and lobbying for increased public awareness, leading to national programs and policies. This paper primarily discusses the value of networks in the delivery of genetic services, specifically newborn screening, programs for rare diseases, birth defects, and genetic counseling.

Telemedicine Versus Traditional In-Person Consultations: Comparison of Patient Satisfaction Rates

Introduction: Data on patient satisfaction with the provision of genetic consultations using telemedicine are limited, especially those involving children. We compared patient satisfaction rates with telemedicine services versus traditional in-person encounters. Methods: A cross-sectional questionnaire-based study was conducted between January and June 2020. Questionnaires were distributed online to 1,672 consecutive patients who had received genetic counseling at our Genetics Institute in the clinical fields of adult and pediatric genetics, oncogenetics, and prenatal genetics, through in-person and/or telemedicine consultation. We used Likert scale with scores of 4-5 representing "satisfied"-"very satisfied" and 1-2 representing "very unsatisfied"-"unsatisfied." Results: The response rate was 27.3% (400 adults and 57 children <18 years), including 330 who had received in-person consultations (72.2%), 80 telemedicine consultations (17.5%), and 47 both consultations (10.3%). Mean satisfactory scores of 4-5 were reported by 82.1% in the in-person group versus 82.5% in the telemedicine group (p = 0.88). Mean scores of 1-2 were reported by 6.3% in the in-person group versus 11.2% in the telemedicine group (p = 0.31). No pediatric telemedicine group patient (n 12 = ) gave scores of 1-2 compared with 2/33 (6%) patients who had in-person pediatric consultations (p = 0.62). Most responders who had been counseled through telemedicine (n = 127, 84%) indicated willingness to use genetic services through telemedicine again. Conclusions: Users of genetic counseling through telemedicine, especially in the pediatric age group, were very satisfied at rates comparable to those of in-person consultations. Future research should evaluate patient compliance and views according to session type, information provided (e.g., diagnostic vs. negative results), and its nature (good vs. bad news).

Perspectives on the Use of Telegenetics Services in the Philippines

The Philippines is a densely populated nation faced with multiple challenges in the healthcare field given its geographic,cultural, and socioeconomic barriers. Due to the geographic limitations of medical services in the country, many patientsmust travel a great distance to referral centers. This was further exacerbated by the Coronavirus disease 2019 (COVID-19)pandemic, which spread across the world and upended lives. This pandemic triggered a public health crisis that impactedhealthcare systems, healthcare workers, and communities worldwide. It compounded current difficulties with the provision andaccessibility of medical services, necessitating the employment of alternative methods of providing health coverage. As a result,advanced technological methods for patient diagnosis, monitoring, treatment, and counseling were rapidly implemented.1 Interest in these technological advances began prior to the COVID-19 pandemic, though primarily in developed countries.However, during this global outbreak, telehealth practices – which refer to online health care services provided by all healthcare professions – have seen a rapid increase in popularity.2,3 Telehealth was brought to the forefront in all countries inorder to surmount lockdown constraints, allow continuous provision of health care for patients, and limit exposure to healthsystems and health providers.4 Traditional medical education and training were likewise disrupted during this time, resulting in the incorporationof telehealth into medical education. To reduce the risks associated with more personnel in the hospital, medical studentswere withdrawn from clinical environments during the COVID-19 outbreak. This created an environment of uncertaintyand limited clinical exposure, with concerns surrounding progression through the medical course and training program.5Continuing medical education, which has traditionally been based on clinical knowledge and skills, now requires onlinetechnical communication skills. Innovative services were rapidly developed with health professionals embracing this newtechnological competence, enabling general consultation for patients, remote patient monitoring, and self-directed patientcare, thereby decreasing the burden on health facilities. Digital learning platforms also provided an effective way to address thelearning gaps caused by the pandemic. The restriction of “in-person” delivery of healthcare services due to the global outbreak has prompted physicians, includingclinical geneticists and genetic counselors, to investigate alternative methods of providing health care to patients. A telehealthinnovation for online delivery of clinical genetic and genetic counseling services is the Philippine General Hospital’s TelegeneticsService. Despite being launched in 2013 to serve genetics patients across the country, this service has since been upgradedand capitalized resulting in patient appreciation for its COVID-19 exposure prevention, increased access, and time and costefficiency. However, the telegenetics service has its limitations.6,7 Despite the expanding scope of telehealth/telegenetics and itsimmediate application, issues such as data/patient privacy, organizational readiness, digital maturity, regulatory impediments,access and acceptance of the technology, geographical and digital disparities, and its integration with traditional medicalservices have emerged.8  Lack of a detailed physical examination is also lost in a virtual visit, with focused questions leading tofragmented, impersonal interactions. Even when restrictions were lifted, telehealth usage nonetheless remained significantly higher than it had been prior tothe pandemic. This may indicate a shift in public opinion in favor of this innovative medical practice.9 With the expansion of genetic services in the country, there is now a greater need for telegenetics due to the increased demand for clinical genetic andgenetic counseling expertise. Therefore, evidence on the safety and efficacy of this technology in comparison to the traditionalhealthcare delivery approach is required. If the technology has the potential to improve health care, we must guarantee itsavailability in all resource-limited areas. Future efforts should thus focus on establishing solutions to address the aforementionedissues and concerns within our healthcare and education systems, thereby ultimately enhancing the standard of medical care. Catherine Lynn T. Silao, MD, PhDInstitute of Human Genetics, National Institutes of HealthDepartment of Pediatrics, College of Medicine and Philippine General HospitalUniversity of the Philippines Manila   REFERENCES 1. Keesara S, Jonas A, Schulman K. COVID-19 and Health Care’sdigital revolution. N Engl J Med. 2020 Jun;382:e82. doi: 10.1056/NEJMp2005835.2. Scott R, Mars M. Telehealth in the developing world: current statusand future prospects. SHTT. 2015;3:25-37. doi:10.2147/shtt.s75184.3. Telemedicine: opportunities and developments in member states -Report on the second global survey on eHealth (Global Observatoryfor eHealth Series, 2). Geneva, Switzerland: World HealthOrganization; 2010.4. Patel SY, Mehrotra A, Huskamp HA, Uscher-Pines L, Ganguli I,Barnett ML. Trends in outpatient care delivery and telemedicineduring the COVID-19 pandemic in the US. JAMA Intern Med.2021 Mar;181(3):388–91. doi: 10.1001/jamainternmed.2020.5928.5. Sharma D, Bhaskar S. Addressing the COVID-19 burden onmedical education and training: the role of telemedicine and teleeducation during and beyond the pandemic. Front Public Health2020 Nov;8:589669. doi: 10.3389/fpubh.2020.589669.6. Herlao IAV, Maceda EBG, Abacan MAR, de Castro Hamoy LG,Alcausin MMLB. Telegenetics services in a tertiary hospital: utilityand patient satisfaction. Acta Med Philipp. 2022. doi: 10.47895/amp.vi0.4981.7. Tumulak MJR, Pascua AV, Jover EJM, Guerbo RJ, Canoy GMR,Laurino MY. Genetic counseling in the time of COVID-19: ThePhilippine experience with telegenetics. J Genet Couns. 2021Oct;30(5):1285-91. doi: 10.1002/jgc4.1518.8. Doraiswamy S, Abraham A, Mamtani R, Cheema S. Use of telehealthduring the COVID-19 pandemic: scoping review. J Med InternetRes. 2020 Dec;22(12):e24087. doi: 10.2196/24087.9. Omboni S, Padwal RS, Alessa T, Benczúr B, Green BB, Hubbard I,et al. The worldwide impact of telemedicine during COVID-19:current evidence and recommendations for the future. 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The growing needs of genetic counselling-Feasibility in utilization of tele-genetic counselling in Asia and Hong Kong

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.

Newborn Screening Long-Term Follow-Up Clinics (Continuity Clinics) in the Philippines during the COVID-19 Pandemic: Continuing Quality Patient Care

The COVID-19 pandemic has challenged healthcare systems worldwide. In the Philippines, long-term care for patients with conditions identified through newborn screening (NBS) is coordinated through Newborn Screening Continuity Clinics (NBSCCs). These clinics are integral to achieving optimal outcomes by providing follow-up oversight and assistance for individuals identified through screening. Continuity of NBSCC care for NBS during the COVID-19 pandemic was both challenging and necessary and was accomplished through innovative strategies of dedicated personnel. Following the discontinuation of the community quarantine, a situation assessment survey was completed by each NBSCC to better understand the challenges encountered and their effect on patient care. Performance data from each NBSCC were reviewed both before and after an extended community quarantine (2018-2021) to evaluate the impact of NBSCC disaster contingency plans in overcoming the resultant challenges (transportation, supply chain, etc.). Thematic analysis of the survey showed three primary challenges: Operations, communications, and safety. In 2018 and 2019, successful patient contacts were 70.6% and 70.2%, respectively. During the pandemic, successful contacts were 74.9% in 2020 and 76.8% in 2021, demonstrating that the contact approaches taken by the NBSCCs were sufficient to maintain (and even improve) patient contacts. The number of unresponsive patients decreased during the pandemic likely due to decreased mobility and improved follow-up actions from the NBSCCs.

Genetic counseling in the time of COVID-19: The Philippine experience with telegenetics

The COVID-19 pandemic poses a significant challenge to healthcare professionals and health systems around the world, most notably the disruption of its service delivery. The typical work setting for most genetic counselors (GCs) is in a clinic or hospital. However, during the COVID-19 pandemic, to help prevent the further spread of the virus, clinics and hospitals have restricted non-urgent in-person delivery of healthcare services, including genetic counseling. Patients' access to genetic counseling services has thus been limited, which prompted GCs in the country to utilize an alternative way to provide counseling through telegenetics. With the expansion of genetic services in the country, including the full implementation of expanded newborn screening, there is an increasing demand for genetic counseling and a growing need for telegenetics.