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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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2
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Loeb S, Cheng HH, Leader A, Gross L, Nolasco TS, Byrne N, Wise DR, Hollifield L, Brown LH, Slater E, Pieczonka C, Gomella LG, Kelly WK, Trabulsi EJ, Handley N, Lallas CD, Chandrasekar T, Mille P, Mann M, Mark JR, Brown G, Chopra S, Wasserman J, Phillips J, Somers P, Giri VN. Technology-enhanced AcceleRation of Germline Evaluation for Therapy (TARGET): A randomized controlled trial of a pretest patient-driven webtool vs. genetic counseling for prostate cancer germline testing. Contemp Clin Trials 2022; 119:106821. [PMID: 35710085 DOI: 10.1016/j.cct.2022.106821] [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: 04/13/2022] [Revised: 06/03/2022] [Accepted: 06/06/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Germline testing has an increasingly important role in prostate cancer care. However, a relative shortage of genetic counselors necessitates alternate strategies for delivery of pre-test education for germline testing. This study, funded by the Prostate Cancer Foundation, seeks to address the need for novel methods of delivery of pre-test germline education beyond traditional germline counseling to facilitate informed patient decision-making for germline testing. METHODS This is a two-armed randomized controlled trial (RCT) with a target enrollment of 173 participants with prostate cancer per study arm (total anticipated n = 346). Patients who meet criteria for germline testing based on tumor features, family history or Ashkenazi Jewish ancestry are being recruited from 5 US sites including academic, private practice and Veterans healthcare settings. Consenting participants are randomized to the interactive pretest webtool or germline counseling with assessment of key patient-reported outcomes involved in informed decision-making for germline germline testing. RESULTS Participants complete surveys at baseline, after pretest education/counseling, and following disclosure of germline germline results. The primary outcome of the study is decisional conflict for germline testing. Secondary outcomes include germline knowledge, satisfaction, uptake of germline testing, and understanding of results. CONCLUSION Our hypothesis is that the web-based germline education tool is non-inferior to traditional germline counseling regarding key patient-reported outcomes involved in informed decision-making for germline testing. If proven, the results would support deploying the webtool across various practice settings to facilitate pre-test germlines education for individuals with prostate cancer and developing collaborative care strategies with germline counseling. CLINICALTRIALS gov Identifier: NCT04447703.
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Affiliation(s)
- Stacy Loeb
- NYU-Langone Health and NYU Perlmutter Cancer Center, New York, NY, United States of America; Manhattan Veteran Affairs, New York, NY, United States of America
| | - Heather H Cheng
- Fred Hutchinson Cancer Center, University of Washington, Seattle, WA, United States of America
| | - Amy Leader
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, United States of America
| | - Laura Gross
- Cancer Risk Assessment and Clinical Cancer Germlines, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, United States of America
| | - Tatiana Sanchez Nolasco
- NYU-Langone Health and NYU Perlmutter Cancer Center, New York, NY, United States of America; Manhattan Veteran Affairs, New York, NY, United States of America
| | - Nataliya Byrne
- NYU-Langone Health and NYU Perlmutter Cancer Center, New York, NY, United States of America; Manhattan Veteran Affairs, New York, NY, United States of America
| | - David R Wise
- NYU-Langone Health and NYU Perlmutter Cancer Center, New York, NY, United States of America
| | - Lucas Hollifield
- NYU-Langone Health and NYU Perlmutter Cancer Center, New York, NY, United States of America
| | - Lauren H Brown
- Fred Hutchinson Cancer Center, University of Washington, Seattle, WA, United States of America
| | - Elias Slater
- Prostate Cancer Foundation, Santa Monica, CA, United States of America
| | | | - Leonard G Gomella
- Department of Urology, Thomas Jefferson University, Philadelphia, PA, United States of America
| | - William K Kelly
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, United States of America
| | - Edouard J Trabulsi
- Department of Urology, Thomas Jefferson University, Philadelphia, PA, United States of America
| | - Nathan Handley
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, United States of America
| | - Costas D Lallas
- Department of Urology, Thomas Jefferson University, Philadelphia, PA, United States of America
| | - Thenappan Chandrasekar
- Department of Urology, Thomas Jefferson University, Philadelphia, PA, United States of America
| | - Patrick Mille
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, United States of America
| | - Mark Mann
- Department of Urology, Thomas Jefferson University, Philadelphia, PA, United States of America
| | - James Ryan Mark
- Department of Urology, Thomas Jefferson University, Philadelphia, PA, United States of America
| | - Gordon Brown
- New Jersey Urology, Voorhees, NJ, United States of America
| | - Sameer Chopra
- New Jersey Urology, Voorhees, NJ, United States of America
| | - Jenna Wasserman
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States of America
| | - Jade Phillips
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States of America
| | - Patrick Somers
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States of America
| | - Veda N Giri
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, United States of America; Cancer Risk Assessment and Clinical Cancer Germlines, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, United States of America; Department of Urology, Thomas Jefferson University, Philadelphia, PA, United States of America.
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3
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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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Khan A, Cohen S, Weir C, Greenberg S. Implementing innovative service delivery models in genetic counseling: a qualitative analysis of facilitators and barriers. J Genet Couns 2020; 30:319-328. [PMID: 32914913 DOI: 10.1002/jgc4.1325] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 08/02/2020] [Accepted: 08/07/2020] [Indexed: 12/18/2022]
Abstract
Given the increasing demand for genetic counseling, implementation of innovative service delivery models (SDMs) has been proposed to improve access and increase the efficiency of genetic counseling services. This study investigated the key considerations in genetic counseling practices that impact the decision to implement innovative SDMs, as well as barriers and facilitators to implementation. A cross-sectional, qualitative research design was employed, using focus groups. Genetic counselors (GCs) were recruited from respondents to an online survey about SDMs and by posting an invitation to the National Society of Genetic Counselors (NSGC) listserv. A total of 30 participants participated in either in-person (n = 3) or online (n = 5) focus groups, facilitated by members of the Service Delivery Model subcommittee of the NSGC Access and Service Delivery Committee. Transcribed audio and written notes from the focus groups were coded, utilizing an inductive thematic analysis method. Five overarching themes that impact decisions to implement and use innovative SDMs were identified: (a) Patient volume and efficiency are key motivators in trying innovative SDMs; (b) the decision to change is facilitated by available resources; (c) the implementation of innovative SDMs is multidimensional and complex process; (d) there is concern about the impact on patient-provider relationships with the utilization of innovative SDMs; and (e) measuring outcomes of innovative SDM facilitates acquisition of additional resources and support. Approaches to innovative SDM selection and implementation vary by institution needs, resources, and population as demonstrated by the variety of approaches to similar barriers. Outcomes related to the implementation of innovative SDMs in genetic counseling practice should be measured to demonstrate the value of innovative genetic counseling SDMs, improvement of access to care, and to justify need for additional resources to support implementation of these models.
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Affiliation(s)
- Ambreen Khan
- University of Utah Graduate Program in Genetic Counseling, Salt Lake City, UT, USA.,Huntsman Cancer Institute, Salt Lake City, UT, USA
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5
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Vora NL, Hardisty E, Coviello E, Stuebe A. Telehealth to provide prenatal genetics services: Feasibility and importance revealed during global pandemic. Prenat Diagn 2020; 40:1040-1041. [PMID: 32314399 DOI: 10.1002/pd.5716] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 04/13/2020] [Accepted: 04/16/2020] [Indexed: 11/06/2022]
Affiliation(s)
- Neeta L Vora
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Emily Hardisty
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Elizabeth Coviello
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Alison Stuebe
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Hulshof HM, Brenner J, Overwater IE, Wit MCD, Braun KPJ, Jansen FE. Counselling in tuberous sclerosis complex: A survey on content and satisfaction in the Netherlands. Eur J Paediatr Neurol 2020; 25:113-119. [PMID: 31982306 DOI: 10.1016/j.ejpn.2020.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 12/22/2019] [Accepted: 01/04/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Tuberous sclerosis complex (TSC) is a highly variable condition and its clinical features cannot reliably be predicted from the genotype. Counselling of parents of a child with TSC is challenging because of the variability of the condition and the changing outlook due to new treatment options. This study explored current counselling strategies in TSC in the Netherlands, with the aim of developing a recommendation for counselling. METHOD We performed a nationwide survey using digital questionnaires. Questionnaires were sent to parents of children diagnosed with TSC, and to medical doctors involved in counselling, both no more than ten years prior to the study. Questions focused on general information about the child with TSC, medical doctors involved in counselling, type of information provided, mode of providing information, and recommendations for improvement of counselling. RESULTS Parents of 34 children diagnosed with TSC (7 prenatally) and 18 medical doctors from different departments responded to the questionnaires. Almost all parents were informed on the neurological and cardiac symptoms of TSC, other symptoms were mentioned less often. Satisfaction on counselling was higher when more information on the variability of TSC was provided, preferentially during a clinical visit, when emotional support was provided, and when parents were notified of the TSC patient society. CONCLUSIONS Information on the variability in expression and quality of life is highly demanded by (expecting) parents of a child with TSC. Furthermore, reference should be made to institutions such as the support organisation for patients and social services for questions and support.
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Affiliation(s)
- Hanna M Hulshof
- Department of Paediatric Neurology, UMC Utrecht Brain Center, Utrecht, the Netherlands.
| | - Juliette Brenner
- Department of Paediatric Neurology, UMC Utrecht Brain Center, Utrecht, the Netherlands
| | - Iris E Overwater
- Department of Paediatric Neurology, Erasmus Medical Center Rotterdam, the Netherlands
| | - Marie-Claire de Wit
- Department of Paediatric Neurology, Erasmus Medical Center Rotterdam, the Netherlands
| | - Kees P J Braun
- Department of Paediatric Neurology, UMC Utrecht Brain Center, Utrecht, the Netherlands
| | - Floor E Jansen
- Department of Paediatric Neurology, UMC Utrecht Brain Center, Utrecht, the Netherlands
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7
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Tutty E, Petelin L, McKinley J, Young MA, Meiser B, Rasmussen VM, Forbes Shepherd R, James PA, Forrest LE. Evaluation of telephone genetic counselling to facilitate germline BRCA1/2 testing in women with high-grade serous ovarian cancer. Eur J Hum Genet 2019; 27:1186-1196. [PMID: 30962500 DOI: 10.1038/s41431-019-0390-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 02/06/2019] [Accepted: 03/19/2019] [Indexed: 01/05/2023] Open
Abstract
Systemic healthcare issues and geographical challenges restrict women's access to BRCA1/2 testing to inform the use of tailored treatments for high-grade serous ovarian cancer. Consequently, BRCA1/2 testing in this population is low and improved testing pathways are urgently needed. This study aimed to determine the acceptability and feasibility of telephone genetic counselling (TGC) to facilitate treatment-focused BRCA1/2 testing in Australia for women with high-grade serous ovarian cancer. Women who received TGC were invited to complete a survey examining their experiences of the service. A cost analysis was conducted to compare the service to standard, in-person genetic counselling. One hundred and seven women responded (48% response rate); 8 had a BRCA1/2 variant affecting function. Geographical barriers prevented women from accessing genetic services in the past. All participants had a positive attitude towards testing, and regret following testing was minimal. While the impact of testing was greater for those with a positive test result, overall, genetic testing did not put the additional psychosocial burden on the participants. Participant's evaluations of the telephone interactions with the genetic counsellors were highly satisfactory. The service was also found to be cost-effective. This model of telephone genetic counselling was an acceptable and effective way to reduce barriers to BRCA1/2 testing for women with ovarian cancer.
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Affiliation(s)
- Erin Tutty
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Lara Petelin
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia
| | - Joanne McKinley
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Mary-Anne Young
- Kinghorn Centre for Clinical Genomics, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
| | - Bettina Meiser
- Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Victoria M Rasmussen
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Rowan Forbes Shepherd
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia
| | - Paul A James
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia
| | - Laura E Forrest
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia. .,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia.
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8
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Terry AB, Wylie A, Raspa M, Vogel B, Sanghavi K, Djurdjinovic L, Caggana M, Bodurtha J. Clinical models of telehealth in genetics: A regional telegenetics landscape. J Genet Couns 2019; 28:673-691. [DOI: 10.1002/jgc4.1088] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 12/03/2018] [Accepted: 12/04/2018] [Indexed: 01/15/2023]
Affiliation(s)
- Alissa B. Terry
- NYMAC Regional Genetics Network; Wadsworth Center; Albany New York
- Genetic Counseling Program; Ferre Institute; Binghamton New York
| | - Amanda Wylie
- NYMAC Regional Genetics Network; Wadsworth Center; Albany New York
- RTI International; Research Triangle Park; North Carolina
| | - Melissa Raspa
- NYMAC Regional Genetics Network; Wadsworth Center; Albany New York
- RTI International; Research Triangle Park; North Carolina
| | - Beth Vogel
- NYMAC Regional Genetics Network; Wadsworth Center; Albany New York
- New York State Department of Health; Wadsworth Center; Albany New York
| | - Kunal Sanghavi
- The Jackson Laboratory for Genomic Medicine; Farmington Connecticut
| | | | - Michele Caggana
- NYMAC Regional Genetics Network; Wadsworth Center; Albany New York
- New York State Department of Health; Wadsworth Center; Albany New York
| | - Joann Bodurtha
- NYMAC Regional Genetics Network; Wadsworth Center; Albany New York
- McKusick-Nathans Institute of Genetic Medicine; Johns Hopkins University; Baltimore Maryland
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Abstract
This article reviews the online-counseling literature with an emphasis on current applications and considerations for future research. It focuses on primary themes of counseling psychology including the history of process-outcome research and multiculturalism. It explores current gaps in the literature from a counseling psychology framework, including the field’s focus on normal and developmental challenges and tasks, client strength and resilience, education and career development, prevention and wellness, and multiculturalism. In general, current evidence indicates that online counseling may be a viable service option for some clients, especially those who are typically isolated; however, questions remain regarding the effectiveness and appropriateness of online counseling.
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10
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Analysis of Advantages, Limitations, and Barriers of Genetic Counseling Service Delivery Models. J Genet Couns 2016; 25:1010-8. [DOI: 10.1007/s10897-016-9932-2] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 01/07/2016] [Indexed: 10/22/2022]
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O'Shea R, Meany M, Carroll C, Cody N, Healy D, Green A, Lynch SA. Predictive Genetic Testing and Alternatives to Face to Face Results Disclosure: A Retrospective Review of Patients Preference for Alternative Modes of BRCA 1 and 2 Results Disclosure in the Republic of Ireland. J Genet Couns 2015; 25:422-31. [PMID: 26407988 DOI: 10.1007/s10897-015-9887-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Accepted: 08/27/2015] [Indexed: 11/28/2022]
Abstract
The traditional model of providing cancer predictive testing services is changing. Many genetic centres are now offering a choice to patients in how they receive their results instead of the typical face-to-face disclosure. In view of this shift in practice and the increasing demand on the ROI cancer predictive testing service, a 2 year retrospective study on patient preference in how to receive a Breast Cancer (BRCA) predictive result was carried out. Results showed that 71.7 % of respondents would have liked to have the option of obtaining their results by telephone or by letter. However, when asked about their actual experience of BRCA predictive results disclosure 40.6 % did still value the face-to-face contact, while 44.9 % would still have preferred to receive results by either post or telephone. No significant difference was found between males and females (p > 0.05) and those who tested negative or positive for the BRCA mutation (p > 0.05) in wanting a choice in how their results were disclosed. While the majority expressed a wish to have a choice in how to receive their results, it is important not to underestimate the value of a face-to-face encounter in these circumstances.
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Affiliation(s)
- Rosie O'Shea
- Department of Clinical Genetics, Our Lady's Hospital for Children, Dublin, Ireland.
| | - Marie Meany
- Department of Clinical Genetics, Our Lady's Hospital for Children, Dublin, Ireland
| | - Cliona Carroll
- Department of Clinical Genetics, Our Lady's Hospital for Children, Dublin, Ireland
| | - Nuala Cody
- Department of Clinical Genetics, Our Lady's Hospital for Children, Dublin, Ireland
| | - David Healy
- Department of Clinical Genetics, Our Lady's Hospital for Children, Dublin, Ireland
| | - Andrew Green
- Department of Clinical Genetics, Our Lady's Hospital for Children, Dublin, Ireland
| | - Sally Ann Lynch
- Department of Clinical Genetics, Our Lady's Hospital for Children, Dublin, Ireland
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12
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A Comparison of Telephone Genetic Counseling and In-Person Genetic Counseling from the Genetic Counselor’s Perspective. J Genet Couns 2015; 25:112-26. [DOI: 10.1007/s10897-015-9848-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 05/18/2015] [Indexed: 10/23/2022]
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13
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Haga SB, Barry WT, Mills R, Svetkey L, Suchindran S, Willard HF, Ginsburg GS. Impact of delivery models on understanding genomic risk for type 2 diabetes. Public Health Genomics 2014; 17:95-104. [PMID: 24577154 DOI: 10.1159/000358413] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Accepted: 12/19/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Genetic information, typically communicated in-person by genetic counselors, can be challenging to comprehend; delivery of this information online--as is becoming more common--has the potential of increasing these challenges. METHODS To address the impact of the mode of delivery of genomic risk information, 300 individuals were recruited from the general public and randomized to receive genomic risk information for type 2 diabetes mellitus in-person from a board-certified genetic counselor or online through the testing company's website. RESULTS Participants were asked to indicate their genomic risk and overall lifetime risk as reported on their test report as well as to interpret their genomic risk (increased, decreased, or same as population). For each question, 59% of participants correctly indicated their risk. Participants who received their results in-person were more likely than those who reviewed their results on-line to correctly interpret their genomic risk (72 vs. 47%, p = 0.0002) and report their actual genomic risk (69 vs. 49%, p = 0.002). CONCLUSIONS The delivery of personal genomic risk through a trained health professional resulted in significantly higher comprehension. Therefore, if the online delivery of genomic test results is to become more widespread, further evaluation of this method of communication may be needed to ensure the effective presentation of results to promote comprehension.
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Affiliation(s)
- S B Haga
- Duke Institute for Genome Sciences and Policy, Duke University, Durham, N.C., USA
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14
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Mills R, Voora D, Peyser B, Haga SB. Delivering pharmacogenetic testing in a primary care setting. PHARMACOGENOMICS & PERSONALIZED MEDICINE 2013; 6:105-12. [PMID: 24101877 PMCID: PMC3791676 DOI: 10.2147/pgpm.s50598] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Pharmacogenetic testing refers to a type of genetic test to predict a patient’s likelihood to experience an adverse event or not respond to a given drug. Despite revision to several labels of commonly prescribed drugs regarding the impact of genetic variation, the use of this testing has been limited in many settings due to a number of factors. In the primary care setting, the limited office time as well as the limited knowledge and experience of primary care practitioners have likely attributed to the slow uptake of pharmacogenetic testing. This paper provides talking points for primary care physicians to discuss with patients when pharmacogenetic testing is warranted. As patients and physicians become more familiar and accepting of pharmacogenetic testing, it is anticipated that discussion time will be comparable to that of other clinical tests.
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Affiliation(s)
- Rachel Mills
- Duke Institute for Genome Sciences and Policy, Durham, NC, USA
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15
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Christensen KD, Green RC. How could disclosing incidental information from whole-genome sequencing affect patient behavior? Per Med 2013; 10:10.2217/pme.13.24. [PMID: 24319470 PMCID: PMC3852635 DOI: 10.2217/pme.13.24] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
In this article, we argue that disclosure of incidental findings from whole-genome sequencing has the potential to motivate individuals to change health behaviors through psychological mechanisms that differ from typical risk assessment interventions. Their ability to do so, however, is likely to be highly contingent upon the nature of the incidental findings and how they are disclosed, the context of the disclosure and the characteristics of the patient. Moreover, clinicians need to be aware that behavioral responses may occur in unanticipated ways. This article argues for commentators and policy makers to take a cautious but optimistic perspective while empirical evidence is collected through ongoing research involving whole-genome sequencing and the disclosure of incidental information.
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Affiliation(s)
- Kurt D Christensen
- Department of Medicine, Division of Genetics, Brigham & Women's Hospital & Harvard Medical School, EC Alumnae Hall, Suite 301, 41 Avenue Louis Pasteur, Boston, MA 02115-5727, USA
| | - Robert C Green
- Department of Medicine, Division of Genetics, Brigham & Women's Hospital & Harvard Medical School, EC Alumnae Hall, Suite 301, 41 Avenue Louis Pasteur, Boston, MA 02115-5727, USA
- Partners Healthcare Center for Personalized Genetic Medicine, Boston, MA, USA
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16
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Conover EA, Polifka JE. The art and science of teratogen risk communication. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2011; 157C:227-33. [DOI: 10.1002/ajmg.c.30308] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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17
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McGee D, Strange C, McClure R, Schwarz L, Erven M. The Alpha-1 Association Genetic Counseling Program: an innovative approach to service. J Genet Couns 2011; 20:330-6. [PMID: 21424325 DOI: 10.1007/s10897-011-9355-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2010] [Accepted: 02/08/2011] [Indexed: 11/25/2022]
Abstract
In an era of specialty medicine, genetic counselors are becoming increasingly focused in their service provision. The Alpha-1 Association Genetic Counseling Program, established in September 2007, specializes in confidential toll-free genetic counseling provided by a certified genetic counselor for Alpha-1 Antitrypsin deficiency, a co-dominant condition associated with lung and/or liver disease. The program received more than 600 callers in its first 2 years. Sixty-seven percent of new callers were family members, carriers, or health professionals. The number of callers increased between the first 2 years, with the greatest increases being family members and health professionals. Testing options and explanation of results encompassed 60% of initial reasons for calls. Seventy-two percent of referrals came from family and friends, test result letters, and the Alpha-1 Association. Between year 1 and 2 family member referrals showed the largest increase. This disease-specific genetic counseling program provides a model that may be useful for other rare disease communities.
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Affiliation(s)
- Dawn McGee
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Medical University of South Carolina, Charleston, SC 29425-6300, USA.
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18
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Bradbury AR, Patrick-Miller L, Fetzer D, Egleston B, Cummings SA, Forman A, Bealin L, Peterson C, Corbman M, O'Connell J, Daly MB. Genetic counselor opinions of, and experiences with telephone communication of BRCA1/2 test results. Clin Genet 2010; 79:125-31. [PMID: 21039431 DOI: 10.1111/j.1399-0004.2010.01540.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BRCA1/2 test disclosure has, historically, been conducted in-person by genetics professionals. Given increasing demand for, and access to, genetic testing, interest in telephone and Internet genetic services, including disclosure of test results, has increased. Semi-structured interviews with genetic counselors were conducted to determine interest in, and experiences with telephone disclosure of BRCA1/2 test results. Descriptive data are summarized with response proportions. One hundred and ninety-four genetic counselors completed self-administered surveys via the web. Although 98% had provided BRCA1/2 results by telephone, 77% had never provided pre-test counseling by telephone. Genetic counselors reported perceived advantages and disadvantages to telephone disclosure. Thirty-two percent of participants described experiences that made them question this practice. Genetic counselors more frequently reported discomfort with telephone disclosure of a positive result or variant of uncertain significance (p < 0.01) than other results. Overall, 73% of participants reported interest in telephone disclosure. Many genetic counselors have provided telephone disclosure, however, most, infrequently. Genetic counselors identify potential advantages and disadvantages to telephone disclosure, and recognize the potential for testing and patient factors to impact patient outcomes. Further research evaluating the impact of testing and patient factors on cognitive, affective, social and behavioral outcomes of alternative models of communicating genetic information is warranted.
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Affiliation(s)
- A R Bradbury
- Department of Clinical Genetics, Fox Chase Cancer Center, Philadelphia, PA 19111-2497, USA.
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19
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Doughty Rice C, Ruschman JG, Martin LJ, Manders JB, Miller E. Retrospective comparison of patient outcomes after in-person and telephone results disclosure counseling for BRCA1/2 genetic testing. Fam Cancer 2010; 9:203-12. [PMID: 20473602 DOI: 10.1007/s10689-009-9303-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Telephone disclosure of BRCA1/2 molecular genetic test results has been proposed as a feasible alternative to traditional in-person results disclosure. The purpose of this study was to investigate the relationship between method of result disclosure with the patient outcome variables of knowledge, cancer worry, cancer risk perception, satisfaction, and cancer screening and prophylactic surgery behaviors. Study participants included 228 women who completed retrospective, self-administered, mailed surveys regarding their pre-test genetic counseling and results disclosure. No significant relationships were found between result disclosure method and the outcome variables investigated. A majority (90%) of individuals who received positive results by telephone returned for follow up visits. Factors which genetic counselors believed influenced their clinical decision to offer telephone disclosure, such as history of breast cancer, a priori risk of genetic mutation and family history of known mutation were not shown to significantly impact the actual disclosure method. This study suggests that telephone results disclosure is clinically appropriate when counselors utilize their clinical judgment to determine which patients are appropriate candidates.
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Affiliation(s)
- Courtney Doughty Rice
- Genetic Counseling Graduate Program, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, USA
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20
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Roberts JS, Shalowitz DI, Christensen KD, Everett JN, Kim SYH, Raskin L, Gruber SB. Returning individual research results: development of a cancer genetics education and risk communication protocol. J Empir Res Hum Res Ethics 2010; 5:17-30. [PMID: 20831418 PMCID: PMC3159194 DOI: 10.1525/jer.2010.5.3.17] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The obligations of researchers to disclose clinically and/or personally significant individual research results are highly debated, but few empirical studies have addressed this topic. We describe the development of a protocol for returning research results to participants at one site of a multicenter study of the genetic epidemiology of melanoma. Protocol development involved numerous challenges: (1) deciding whether genotype results merited disclosure; (2) achieving an appropriate format for communicating results; (3) developing education materials; (4) deciding whether to retest samples for additional laboratory validation; (5) identifying and notifying selected participants; and (6) assessing the impact of disclosure. Our experience suggests potential obstacles depending on researcher resources and the design of the parent study, but offers a process by which researchers can responsibly return individual study results and evaluate the impact of disclosure.
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Affiliation(s)
- J Scott Roberts
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI 48109-2029, USA.
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21
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O'Daniel JM. The prospect of genome-guided preventive medicine: a need and opportunity for genetic counselors. J Genet Couns 2010; 19:315-27. [PMID: 20440545 DOI: 10.1007/s10897-010-9302-4] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2009] [Accepted: 04/07/2010] [Indexed: 12/22/2022]
Abstract
One of the major anticipated benefits of genomic medicine is the area of preventive medicine. Commercially available genomic profiling is now able to generate risk information for a number of common conditions several of which have recognized preventive guidelines. Similarly, family history assessment affords powerful health risk prediction based on the shared genetic, physical and lifestyle environments within families. Thus, with the ability to help predict disease risk and enable preemptive health plans, genome-guided preventive medicine has the potential to improve population health on an individualized level. To realize this potential, steps to broaden access to accurate genomic health information must be considered. With expertise in genetic science, risk assessment and communication, and a patient-centered practice approach, genetic counselors are poised to play a critical role in facilitating the incorporation of genomic health risks into the burgeoning field of genome-guided preventive medicine.
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Affiliation(s)
- Julianne M O'Daniel
- Duke Institute for Genome Sciences & Policy, Duke University, 450 Research Drive, LSRC B342C, Box 91009, Durham, NC 27708, USA.
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22
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Zilliacus EM, Meiser B, Lobb EA, Kirk J, Warwick L, Tucker K. Women's experience of telehealth cancer genetic counseling. J Genet Couns 2010; 19:463-72. [PMID: 20411313 DOI: 10.1007/s10897-010-9301-5] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2009] [Accepted: 03/25/2010] [Indexed: 12/20/2022]
Abstract
Telegenetics offers an alternative model of delivering genetic counseling to rural and outreach areas; however there is a dearth of qualitative research into the patient's experience. Twelve women who had received telemedicine genetic counseling for hereditary breast and/or ovarian cancer (HBOC) within the previous 12 months participated in a semi-structured telephone interview. The interview explored women's experience with telegenetics, satisfaction, perceived advantages and disadvantages and quality of the interaction with their genetic professionals. Overall women were highly satisfied with telegenetics. Telegenetics offered them convenience and reduced travel and associated costs. The majority of women described feeling a high degree of social presence, or rapport, with the off-site genetic clinician. One woman with a recent cancer diagnosis, reported that telemedicine was unable to meet her needs for psychosocial support. This finding highlights the need to be mindful of the psychosocial support needs of women with a recent diagnosis being seen via telegenetics. Patients attending for HBOC genetic counseling are generally highly satisfied with the technology and the interaction. Care should be taken, however, with patients with more complex psychosocial needs.
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Affiliation(s)
- Elvira M Zilliacus
- Department of Medical Oncology, Prince of Wales Hospital, Randwick, NSW, Australia.
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23
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Mackenzie A, Patrick-Miller L, Bradbury AR. Controversies in communication of genetic risk for hereditary breast cancer. Breast J 2009; 15 Suppl 1:S25-32. [PMID: 19775327 DOI: 10.1111/j.1524-4741.2009.00800.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Increased availability and heightened consumer awareness of "cancer genes" has increased consumer interest in, and demand for breast cancer risk assessment, and thus a pressing need for providers to identify effective, efficient methods of communicating complicated genetic information to consumers and their potentially at-risk relatives. With increasing direct-to-consumer and -physician marketing of predictive genetic tests, there has been considerable growth in web- and telephone-based genetic services. There is urgent need to further evaluate the psychosocial and behavioral outcomes (i.e., risks and benefits) of telephone and web-based methods of delivery before they become fully incorporated into clinical care models. Given the implications of genetic test results for family members, and the inherent conflicts in health care providers' dual responsibilities to protect patient privacy and to "warn" those at-risk, new models for communicating risk to at-risk relatives are emerging. Additional controversies arise when the at-risk relative is a minor. Research evaluating the impact of communicating genetic risk to offspring is necessary to inform optimal communication of genetic risk for breast cancer across the lifespan. Better understanding the risks and benefits associated with each of these controversial areas in cancer risk communication are crucial to optimizing adherence to recommended breast cancer risk management strategies and ensuring psycho-social well-being in the clinical delivery of genetic services for breast cancer susceptibility.
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Affiliation(s)
- Amy Mackenzie
- Department of Medicine, Fox Chase Cancer Center, Philadelphia, PA, USA
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Abstract
Genetic testing for mutations in genes associated with an inherited predisposition to cancer is rapidly moving outside specialty genetic services and into mainstream health care. Surgeons, as front-line providers of cancer care, are uniquely positioned to identify those who may benefit from genetic testing and institute changes to their health care management based on those results. This article provides an overview of the critical elements of the process of genetic testing for cancer susceptibility.
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Peshkin BN, Demarco TA, Graves KD, Brown K, Nusbaum RH, Moglia D, Forman A, Valdimarsdottir H, Schwartz MD. Telephone genetic counseling for high-risk women undergoing BRCA1 and BRCA2 testing: rationale and development of a randomized controlled trial. ACTA ACUST UNITED AC 2008; 12:37-52. [PMID: 18373403 DOI: 10.1089/gte.2006.0525] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Genetic counseling and testing, particularly for adult onset conditions, has become increasingly available over the last decade, and it is expected that this trend will continue as additional genes are identified and as such testing diffuses into mainstream clinical care. To meet the increased demand for services, it will become necessary to explore alternative avenues to traditional face-to-face genetic counseling. One such modality is the use of telephone genetic counseling (TGC), which is easy to implement and still allows for comprehensive service delivery. Although TGC has been used with increased frequency, there is a paucity of data about its effectiveness and impact on important patient outcomes. This paper provides an overview of the evolution of telephone counseling in nongenetics and genetics settings. The rationale and aims of the largest randomized clinical trial to be performed with this mode of counseling in the context of cancer susceptibility testing for mutations in the BRCA1 and BRCA2 genes are also explained. In addition, procedural aspects of the genetic counseling intervention and the novel tools developed to facilitate this process and to ensure adequate counselor training and quality assurance are described.
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Affiliation(s)
- Beth N Peshkin
- Lombardi Comprehensive Cancer Center, Jess and Mildred Fisher Center for Familial Cancer Research Georgetown University, Washington, District of Columbia 20007-2401, USA.
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26
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DeMarco TA, Smith KL, Nusbaum RH, Peshkin BN, Schwartz MD, Isaacs C. Practical Aspects of Delivering Hereditary Cancer Risk Counseling. Semin Oncol 2007; 34:369-78. [DOI: 10.1053/j.seminoncol.2007.07.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Abstract
Molecular pathological tests are performed on stored tumour material in order to identify individuals with hereditary non-polyposis colorectal cancer. We have previously identified that there is widespread use of this testing and now describe what counselling occurs prior to testing and the approaches in seeking consent. A respondent from every cancer genetic centre in UK offering microsatellite instability and/or immunohistochemistry testing (n= 20, response rate = 100%) was interviewed in order to ascertain pre-test counselling and consent protocols. Individuals providing consent are not always seen in person prior to providing consent but few services had supporting written information. Nine (of 19) consent forms documented consent to perform genetic testing, while the majority (14/19) sought consent to release pathology samples to the genetic service. Less than half of the services routinely seek consent to test samples from a deceased individual. Concerns were raised about spousal consent when the implications of results are for blood relatives. The differences identified between genetic counselling for testing of tumour tissue and for germ-line genetic testing suggest that counselling protocols specific for somatic testing should be developed. The results are discussed in the context of a changing legal environment and anticipated growing demand for testing.
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Affiliation(s)
- C L Gaff
- Department of Medical Genetics, Cardiff University, Cardiff, UK.
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Helmes AW, Culver JO, Bowen DJ. Results of a randomized study of telephone versus in-person breast cancer risk counseling. PATIENT EDUCATION AND COUNSELING 2006; 64:96-103. [PMID: 16427245 DOI: 10.1016/j.pec.2005.12.002] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2005] [Revised: 11/23/2005] [Accepted: 12/02/2005] [Indexed: 05/06/2023]
Abstract
OBJECTIVE Women of all risk levels have reported high interest in obtaining genetic testing for breast cancer risk. Breast cancer risk counseling may help women to learn about their risk and appropriate options of testing. This study measured the effects of an intervention in-person and by telephone, compared to a control group. METHODS Participants were 340 women, recruited through a network of primary care physicians. They received a baseline questionnaire in the mail, were randomized to one of the three study arms, and completed a follow-up survey 3 months later. RESULTS Both types of counseling were very well received. The counseling decreased women's cancer worry, risk perceptions, and intentions to pursue genetic testing. There were similar effects for both in-person and telephone counseling. CONCLUSION Genetic counseling can be used to inform women at all risk levels about their breast cancer risk. PRACTICE IMPLICATIONS Breast cancer risk counseling can be done in-person and by telephone--thereby reaching women in remote areas.
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Affiliation(s)
- Almut W Helmes
- Institute of Psychology, Department of Rehabilitation Psychology, University of Freiburg, 79085 Freiburg, Germany.
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29
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Abrams DJ, Geier MR. A Comparison of Patient Satisfaction with Telehealth and On-Site Consultations: A Pilot Study for Prenatal Genetic Counseling. J Genet Couns 2006; 15:199-205. [PMID: 16779676 DOI: 10.1007/s10897-006-9020-0] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Many different fields of medicine are now utilizing video conferencing as a means to offer consultations to individuals in rural communities. However, there is a lack of published literature regarding the use of telehealth in clinical genetics and, specifically, in genetic counseling. Those experiences that have been reported mostly centered on cancer genetic counseling, sickle cell anemia consultation and care, or pediatric/adult genetic assessment. In these studies, the patients reported an overall satisfaction with telehealth, signifying that this type of communication may play an important role in the future of medicine. This pilot study compared patient satisfaction with prenatal genetic counseling performed via video conferencing versus that performed on-site. The results show that there was a high level of patient satisfaction when video conferencing was used to conduct prenatal genetic counseling consultations, suggesting that telehealth can be utilized as a means to offer this service to underserved populations.
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Affiliation(s)
- Debra J Abrams
- The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, Pennsylvania 19104, USA.
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Coelho JJ, Arnold A, Nayler J, Tischkowitz M, MacKay J. An assessment of the efficacy of cancer genetic counselling using real-time videoconferencing technology (telemedicine) compared to face-to-face consultations. Eur J Cancer 2005; 41:2257-61. [PMID: 16176873 DOI: 10.1016/j.ejca.2005.06.020] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2005] [Accepted: 06/22/2005] [Indexed: 11/21/2022]
Abstract
There are few published studies regarding the use of telemedicine in counselling families with a history of cancer. In this study, cancer genetic counselling was evaluated when conducted via telemedicine and compared to face-to-face consultations. Participants were placed into a telemedicine group or a face-to-face group depending on their geographical location. Telemedicine consultations took place using real-time videoconferencing technology ISDN6 digital telephone lines. Sixteen participants were evaluated in the telemedicine compared to 21 in the face-to-face group and all participants were asked to complete both a precounselling and postcounselling questionnaire, which assessed their understanding of cancer genetics, anxiety levels, satisfaction levels, and allowed for personal comments. In both the telemedicine and face-to-face groups, a significant reduction in cancer related anxiety levels and high satisfaction levels were reported. There was a trend towards increased cancer genetic knowledge post genetic counselling in both groups. The results show that telemedicine is a useful alternative by which to provide cancer genetic services when geographical distance is an issue.
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Phelps C, Platt K, France L, Gray J, Iredale R. Delivering information about cancer genetics via letter to patients at low and moderate risk of familial cancer: a pilot study in Wales. Fam Cancer 2004; 3:55-9. [PMID: 15131407 DOI: 10.1023/b:fame.0000026838.92085.ec] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Increasing demands upon specialist cancer genetics services have resulted in a need to explore alternative means of delivering genetic risk information to individuals at low-risk of familial cancer. This pilot study investigates patient satisfaction with a letter to low and moderate risk individuals notifying them of their risk. Sixty-six people completed a questionnaire designed to measure satisfaction with the way they had been notified of their cancer risk. Two key findings emerge from the data: first of all, whilst many respondents indicated overall satisfaction with the risk letter, a substantial number wanted more information about their risk; and secondly, low-risk individuals in this study are less reassured by and less satisfied with the risk letter than those at moderate risk. The optimal service provision for delivery of genetic risk information is likely to be one which can best respond to individual differences in information-seeking, distress and risk comprehension. There is a need therefore, for a randomised control trial to compare the effectiveness of a risk notification letter with more traditional telephone risk counselling and the implications of each mode of delivery upon the resources of specialist cancer genetics services.
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Affiliation(s)
- C Phelps
- Department of General Practice, University of Wales College of Medicine, Cardiff, UK
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