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Bradbury AR, Patrick-Miller LJ, Egleston BL, Hall MJ, Domchek SM, Daly MB, Ganschow P, Grana G, Olopade OI, Fetzer D, Brandt A, Chambers R, Clark DF, Forman A, Gaber R, Gulden C, Horte J, Long JM, Lucas T, Madaan S, Mattie K, McKenna D, Montgomery S, Nielsen S, Powers J, Rainey K, Rybak C, Savage M, Seelaus C, Stoll J, Stopfer JE, Yao XS. Randomized Noninferiority Trial of Telephone vs In-Person Disclosure of Germline Cancer Genetic Test Results. J Natl Cancer Inst 2019; 110:985-993. [PMID: 29490071 DOI: 10.1093/jnci/djy015] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 01/18/2018] [Indexed: 12/16/2022] Open
Abstract
Background Germline genetic testing is standard practice in oncology. Outcomes of telephone disclosure of a wide range of cancer genetic test results, including multigene panel testing (MGPT) are unknown. Methods Patients undergoing cancer genetic testing were recruited to a multicenter, randomized, noninferiority trial (NCT01736345) comparing telephone disclosure (TD) of genetic test results with usual care, in-person disclosure (IPD) after tiered-binned in-person pretest counseling. Primary noninferiority outcomes included change in knowledge, state anxiety, and general anxiety. Secondary outcomes included cancer-specific distress, depression, uncertainty, satisfaction, and screening and risk-reducing surgery intentions. To declare noninferiority, we calculated the 98.3% one-sided confidence interval of the standardized effect; t tests were used for secondary subgroup analyses. Only noninferiority tests were one-sided, others were two-sided. Results A total of 1178 patients enrolled in the study. Two hundred eight (17.7%) participants declined random assignment due to a preference for in-person disclosure; 473 participants were randomly assigned to TD and 497 to IPD; 291 (30.0%) had MGPT. TD was noninferior to IPD for general and state anxiety and all secondary outcomes immediately postdisclosure. TD did not meet the noninferiority threshold for knowledge in the primary analysis, but it did meet the threshold in the multiple imputation analysis. In secondary analyses, there were no statistically significant differences between arms in screening and risk-reducing surgery intentions, and no statistically significant differences in outcomes by arm among those who had MGPT. In subgroup analyses, patients with a positive result had statistically significantly greater decreases in general anxiety with telephone disclosure (TD -0.37 vs IPD +0.87, P = .02). Conclusions Even in the era of multigene panel testing, these data suggest that telephone disclosure of cancer genetic test results is as an alternative to in-person disclosure for interested patients after in-person pretest counseling with a genetic counselor.
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Affiliation(s)
- Angela R Bradbury
- Division of Hematology-Oncology, Department of Medicine, Department of Medical Ethics and Health Policy, and Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Linda J Patrick-Miller
- Division of Hematology-Oncology and Section of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, and Center for Clinical Cancer Genetics and Global Health, The University of Chicago, Chicago, IL
| | - Brian L Egleston
- Biostatistics and Bioinformatics Facility and Department of Medical Genetics, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA
| | - Michael J Hall
- Biostatistics and Bioinformatics Facility and Department of Medical Genetics, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA
| | - Susan M Domchek
- Division of Hematology-Oncology, Department of Medicine, Department of Medical Ethics and Health Policy, and Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Mary B Daly
- Biostatistics and Bioinformatics Facility and Department of Medical Genetics, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA
| | - Pamela Ganschow
- Department of Internal Medicine, The John H. Stroger Jr. Hospital of Cook County, Chicago, IL
| | - Generosa Grana
- Division of Hematology-Oncology, MD Anderson Cancer Center at Cooper, Camden, NJ
| | - Olufunmilayo I Olopade
- Division of Hematology-Oncology and Section of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, and Center for Clinical Cancer Genetics and Global Health, The University of Chicago, Chicago, IL
| | - Dominique Fetzer
- Division of Hematology-Oncology, Department of Medicine, Department of Medical Ethics and Health Policy, and Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Amanda Brandt
- Division of Hematology-Oncology, Department of Medicine, Department of Medical Ethics and Health Policy, and Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Rachelle Chambers
- Division of Hematology-Oncology and Section of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, and Center for Clinical Cancer Genetics and Global Health, The University of Chicago, Chicago, IL
| | - Dana F Clark
- Division of Hematology-Oncology, MD Anderson Cancer Center at Cooper, Camden, NJ
| | - Andrea Forman
- Biostatistics and Bioinformatics Facility and Department of Medical Genetics, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA
| | - Rikki Gaber
- Department of Internal Medicine, The John H. Stroger Jr. Hospital of Cook County, Chicago, IL
| | - Cassandra Gulden
- Division of Hematology-Oncology and Section of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, and Center for Clinical Cancer Genetics and Global Health, The University of Chicago, Chicago, IL
| | - Janice Horte
- Division of Hematology-Oncology, MD Anderson Cancer Center at Cooper, Camden, NJ
| | - Jessica M Long
- Division of Hematology-Oncology, Department of Medicine, Department of Medical Ethics and Health Policy, and Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Terra Lucas
- Department of Internal Medicine, The John H. Stroger Jr. Hospital of Cook County, Chicago, IL
| | - Shreshtha Madaan
- Division of Hematology-Oncology and Section of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, and Center for Clinical Cancer Genetics and Global Health, The University of Chicago, Chicago, IL
| | - Kristin Mattie
- Division of Hematology-Oncology, MD Anderson Cancer Center at Cooper, Camden, NJ
| | - Danielle McKenna
- Division of Hematology-Oncology, Department of Medicine, Department of Medical Ethics and Health Policy, and Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Susan Montgomery
- Biostatistics and Bioinformatics Facility and Department of Medical Genetics, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA
| | - Sarah Nielsen
- Division of Hematology-Oncology and Section of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, and Center for Clinical Cancer Genetics and Global Health, The University of Chicago, Chicago, IL
| | - Jacquelyn Powers
- Division of Hematology-Oncology, Department of Medicine, Department of Medical Ethics and Health Policy, and Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Kim Rainey
- Biostatistics and Bioinformatics Facility and Department of Medical Genetics, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA
| | - Christina Rybak
- Biostatistics and Bioinformatics Facility and Department of Medical Genetics, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA
| | - Michelle Savage
- Biostatistics and Bioinformatics Facility and Department of Medical Genetics, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA
| | - Christina Seelaus
- Department of Internal Medicine, The John H. Stroger Jr. Hospital of Cook County, Chicago, IL
| | - Jessica Stoll
- Division of Hematology-Oncology and Section of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, and Center for Clinical Cancer Genetics and Global Health, The University of Chicago, Chicago, IL
| | - Jill E Stopfer
- Division of Hematology-Oncology, Department of Medicine, Department of Medical Ethics and Health Policy, and Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Xinxin Shirley Yao
- Division of Hematology-Oncology, MD Anderson Cancer Center at Cooper, Camden, NJ
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Experiences of Genetic Counselors Practicing in Rural Areas. J Genet Couns 2017; 27:140-154. [PMID: 28831644 DOI: 10.1007/s10897-017-0131-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 07/13/2017] [Indexed: 12/19/2022]
Abstract
In-person genetic counseling clinics in rural areas are likely to improve access to genetic counseling in underserved regions, but studies have not previously examined how these clinics function or described the experience of practicing in a rural setting. The present mixed-methods study explored the professional experiences of clinical genetic counselors who practice in rural areas, including the benefits and challenges of practicing in these settings and the counselors' motivations for doing so. The authors surveyed 20 genetic counselors who self-reported working in rural areas and conducted interviews with six individuals whose workplaces were confirmed as rural per RUCA code. Major obstacles to the provision of genetics services in rural areas included travel distance and low referral rates due to lack of awareness or skepticism. Facilitating factors included relying on resources such as professional networks and prioritizing outreach and education. Participants reported high professional satisfaction and were motivated to work in rural areas by personal experiences and qualities of the job such as being a generalist and having greater professional autonomy. These data demonstrate the feasibility of practicing in rural settings and suggest that in-person rural genetic counseling clinics may complement other strategies such as alternative service delivery models in increasing access for rural residents.
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Kinney AY, Steffen LE, Brumbach BH, Kohlmann W, Du R, Lee JH, Gammon A, Butler K, Buys SS, Stroup AM, Campo RA, Flores KG, Mandelblatt JS, Schwartz MD. Randomized Noninferiority Trial of Telephone Delivery of BRCA1/2 Genetic Counseling Compared With In-Person Counseling: 1-Year Follow-Up. J Clin Oncol 2016; 34:2914-24. [PMID: 27325848 PMCID: PMC5012661 DOI: 10.1200/jco.2015.65.9557] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
PURPOSE The ongoing integration of cancer genomic testing into routine clinical care has led to increased demand for cancer genetic services. To meet this demand, there is an urgent need to enhance the accessibility and reach of such services, while ensuring comparable care delivery outcomes. This randomized trial compared 1-year outcomes for telephone genetic counseling with in-person counseling among women at risk of hereditary breast and/or ovarian cancer living in geographically diverse areas. PATIENTS AND METHODS Using population-based sampling, women at increased risk of hereditary breast and/or ovarian cancer were randomly assigned to in-person (n = 495) or telephone genetic counseling (n = 493). One-sided 97.5% CIs were used to estimate the noninferiority effects of telephone counseling on 1-year psychosocial, decision-making, and quality-of-life outcomes. Differences in test-uptake proportions for determining equivalency of a 10% prespecified margin were evaluated by 95% CIs. RESULTS At the 1-year follow-up, telephone counseling was noninferior to in-person counseling for all psychosocial and informed decision-making outcomes: anxiety (difference [d], 0.08; upper bound 97.5% CI, 0.45), cancer-specific distress (d, 0.66; upper bound 97.5% CI, 2.28), perceived personal control (d, -0.01; lower bound 97.5% CI, -0.06), and decisional conflict (d, -0.12; upper bound 97.5% CI, 2.03). Test uptake was lower for telephone counseling (27.9%) than in-person counseling (37.3%), with the difference of 9.4% (95% CI, 2.2% to 16.8%). Uptake was appreciably higher for rural compared with urban dwellers in both counseling arms. CONCLUSION Although telephone counseling led to lower testing uptake, our findings suggest that telephone counseling can be effectively used to increase reach and access without long-term adverse psychosocial consequences. Further work is needed to determine long-term adherence to risk management guidelines and effective strategies to boost utilization of primary and secondary preventive strategies.
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Affiliation(s)
- Anita Y Kinney
- Anita Y. Kinney, Laurie E. Steffen, Barbara H. Brumbach, Ruofei Du, Ji-Hyun Lee, Karin Butler, and Kristina G. Flores, University of New Mexico, Albuquerque, NM; Wendy Kohlmann, Amanda Gammon, and Saundra S. Buys, University of Utah, Salt Lake City, UT; Antoinette M. Stroup, Rutgers, The State University of New Jersey, New Brunswick, NJ; Rebecca A. Campo, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Jeanne S. Mandelblatt and Marc D. Schwartz, Georgetown University, Washington, DC.
| | - Laurie E Steffen
- Anita Y. Kinney, Laurie E. Steffen, Barbara H. Brumbach, Ruofei Du, Ji-Hyun Lee, Karin Butler, and Kristina G. Flores, University of New Mexico, Albuquerque, NM; Wendy Kohlmann, Amanda Gammon, and Saundra S. Buys, University of Utah, Salt Lake City, UT; Antoinette M. Stroup, Rutgers, The State University of New Jersey, New Brunswick, NJ; Rebecca A. Campo, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Jeanne S. Mandelblatt and Marc D. Schwartz, Georgetown University, Washington, DC
| | - Barbara H Brumbach
- Anita Y. Kinney, Laurie E. Steffen, Barbara H. Brumbach, Ruofei Du, Ji-Hyun Lee, Karin Butler, and Kristina G. Flores, University of New Mexico, Albuquerque, NM; Wendy Kohlmann, Amanda Gammon, and Saundra S. Buys, University of Utah, Salt Lake City, UT; Antoinette M. Stroup, Rutgers, The State University of New Jersey, New Brunswick, NJ; Rebecca A. Campo, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Jeanne S. Mandelblatt and Marc D. Schwartz, Georgetown University, Washington, DC
| | - Wendy Kohlmann
- Anita Y. Kinney, Laurie E. Steffen, Barbara H. Brumbach, Ruofei Du, Ji-Hyun Lee, Karin Butler, and Kristina G. Flores, University of New Mexico, Albuquerque, NM; Wendy Kohlmann, Amanda Gammon, and Saundra S. Buys, University of Utah, Salt Lake City, UT; Antoinette M. Stroup, Rutgers, The State University of New Jersey, New Brunswick, NJ; Rebecca A. Campo, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Jeanne S. Mandelblatt and Marc D. Schwartz, Georgetown University, Washington, DC
| | - Ruofei Du
- Anita Y. Kinney, Laurie E. Steffen, Barbara H. Brumbach, Ruofei Du, Ji-Hyun Lee, Karin Butler, and Kristina G. Flores, University of New Mexico, Albuquerque, NM; Wendy Kohlmann, Amanda Gammon, and Saundra S. Buys, University of Utah, Salt Lake City, UT; Antoinette M. Stroup, Rutgers, The State University of New Jersey, New Brunswick, NJ; Rebecca A. Campo, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Jeanne S. Mandelblatt and Marc D. Schwartz, Georgetown University, Washington, DC
| | - Ji-Hyun Lee
- Anita Y. Kinney, Laurie E. Steffen, Barbara H. Brumbach, Ruofei Du, Ji-Hyun Lee, Karin Butler, and Kristina G. Flores, University of New Mexico, Albuquerque, NM; Wendy Kohlmann, Amanda Gammon, and Saundra S. Buys, University of Utah, Salt Lake City, UT; Antoinette M. Stroup, Rutgers, The State University of New Jersey, New Brunswick, NJ; Rebecca A. Campo, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Jeanne S. Mandelblatt and Marc D. Schwartz, Georgetown University, Washington, DC
| | - Amanda Gammon
- Anita Y. Kinney, Laurie E. Steffen, Barbara H. Brumbach, Ruofei Du, Ji-Hyun Lee, Karin Butler, and Kristina G. Flores, University of New Mexico, Albuquerque, NM; Wendy Kohlmann, Amanda Gammon, and Saundra S. Buys, University of Utah, Salt Lake City, UT; Antoinette M. Stroup, Rutgers, The State University of New Jersey, New Brunswick, NJ; Rebecca A. Campo, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Jeanne S. Mandelblatt and Marc D. Schwartz, Georgetown University, Washington, DC
| | - Karin Butler
- Anita Y. Kinney, Laurie E. Steffen, Barbara H. Brumbach, Ruofei Du, Ji-Hyun Lee, Karin Butler, and Kristina G. Flores, University of New Mexico, Albuquerque, NM; Wendy Kohlmann, Amanda Gammon, and Saundra S. Buys, University of Utah, Salt Lake City, UT; Antoinette M. Stroup, Rutgers, The State University of New Jersey, New Brunswick, NJ; Rebecca A. Campo, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Jeanne S. Mandelblatt and Marc D. Schwartz, Georgetown University, Washington, DC
| | - Saundra S Buys
- Anita Y. Kinney, Laurie E. Steffen, Barbara H. Brumbach, Ruofei Du, Ji-Hyun Lee, Karin Butler, and Kristina G. Flores, University of New Mexico, Albuquerque, NM; Wendy Kohlmann, Amanda Gammon, and Saundra S. Buys, University of Utah, Salt Lake City, UT; Antoinette M. Stroup, Rutgers, The State University of New Jersey, New Brunswick, NJ; Rebecca A. Campo, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Jeanne S. Mandelblatt and Marc D. Schwartz, Georgetown University, Washington, DC
| | - Antoinette M Stroup
- Anita Y. Kinney, Laurie E. Steffen, Barbara H. Brumbach, Ruofei Du, Ji-Hyun Lee, Karin Butler, and Kristina G. Flores, University of New Mexico, Albuquerque, NM; Wendy Kohlmann, Amanda Gammon, and Saundra S. Buys, University of Utah, Salt Lake City, UT; Antoinette M. Stroup, Rutgers, The State University of New Jersey, New Brunswick, NJ; Rebecca A. Campo, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Jeanne S. Mandelblatt and Marc D. Schwartz, Georgetown University, Washington, DC
| | - Rebecca A Campo
- Anita Y. Kinney, Laurie E. Steffen, Barbara H. Brumbach, Ruofei Du, Ji-Hyun Lee, Karin Butler, and Kristina G. Flores, University of New Mexico, Albuquerque, NM; Wendy Kohlmann, Amanda Gammon, and Saundra S. Buys, University of Utah, Salt Lake City, UT; Antoinette M. Stroup, Rutgers, The State University of New Jersey, New Brunswick, NJ; Rebecca A. Campo, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Jeanne S. Mandelblatt and Marc D. Schwartz, Georgetown University, Washington, DC
| | - Kristina G Flores
- Anita Y. Kinney, Laurie E. Steffen, Barbara H. Brumbach, Ruofei Du, Ji-Hyun Lee, Karin Butler, and Kristina G. Flores, University of New Mexico, Albuquerque, NM; Wendy Kohlmann, Amanda Gammon, and Saundra S. Buys, University of Utah, Salt Lake City, UT; Antoinette M. Stroup, Rutgers, The State University of New Jersey, New Brunswick, NJ; Rebecca A. Campo, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Jeanne S. Mandelblatt and Marc D. Schwartz, Georgetown University, Washington, DC
| | - Jeanne S Mandelblatt
- Anita Y. Kinney, Laurie E. Steffen, Barbara H. Brumbach, Ruofei Du, Ji-Hyun Lee, Karin Butler, and Kristina G. Flores, University of New Mexico, Albuquerque, NM; Wendy Kohlmann, Amanda Gammon, and Saundra S. Buys, University of Utah, Salt Lake City, UT; Antoinette M. Stroup, Rutgers, The State University of New Jersey, New Brunswick, NJ; Rebecca A. Campo, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Jeanne S. Mandelblatt and Marc D. Schwartz, Georgetown University, Washington, DC
| | - Marc D Schwartz
- Anita Y. Kinney, Laurie E. Steffen, Barbara H. Brumbach, Ruofei Du, Ji-Hyun Lee, Karin Butler, and Kristina G. Flores, University of New Mexico, Albuquerque, NM; Wendy Kohlmann, Amanda Gammon, and Saundra S. Buys, University of Utah, Salt Lake City, UT; Antoinette M. Stroup, Rutgers, The State University of New Jersey, New Brunswick, NJ; Rebecca A. Campo, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Jeanne S. Mandelblatt and Marc D. Schwartz, Georgetown University, Washington, DC
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Peshkin BN, Kelly S, Nusbaum RH, Similuk M, DeMarco TA, Hooker GW, Valdimarsdottir HB, Forman AD, Joines JR, Davis C, McCormick SR, McKinnon W, Graves KD, Isaacs C, Garber J, Wood M, Jandorf L, Schwartz MD. Patient Perceptions of Telephone vs. In-Person BRCA1/BRCA2 Genetic Counseling. J Genet Couns 2016; 25:472-82. [PMID: 26455498 PMCID: PMC4829475 DOI: 10.1007/s10897-015-9897-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 09/23/2015] [Indexed: 10/22/2022]
Abstract
Telephone genetic counseling (TC) for hereditary breast/ovarian cancer risk has been associated with positive outcomes in high risk women. However, little is known about how patients perceive TC. As part of a randomized trial of TC versus usual care (UC; in-person genetic counseling), we compared high risk women's perceptions of: (1) overall satisfaction with genetic counseling; (2) convenience; (3) attentiveness during the session; (4) counselor effectiveness in providing support; and (5) counselor ability to recognize emotional responses during the session. Among the 554 participants (TC, N = 272; UC, N = 282), delivery mode was not associated with self-reported satisfaction. However, TC participants found counseling significantly more convenient than UC participants (OR = 4.78, 95 % CI = 3.32, 6.89) while also perceiving lower levels of support (OR = 0.56, 95 % CI = 0.40-0.80) and emotional recognition (OR = 0.53, 95 % CI = 0.37-0.76). In exploratory analyses, we found that non-Hispanic white participants reported higher counselor support in UC than in TC (69.4 % vs. 52.8 %; OR = 3.06, 95 % CI = 1.39-6.74), while minority women perceived less support in UC vs. TC (58.3 % vs. 38.7 %; OR = 0.80, 95 % CI = 0.39-1.65). We discuss potential research and practice implications of these findings which may further improve the effectiveness and utilization of TC.
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Affiliation(s)
- Beth N Peshkin
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA.
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA.
| | - Scott Kelly
- Department of Epidemiology and Biostatistics, George Washington University, Washington, DC, USA
| | | | - Morgan Similuk
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Tiffani A DeMarco
- Cancer Genetic Counseling Program, Inova Translational Medicine Institute, Inova Health System, Falls Church, VA, USA
| | | | - Heiddis B Valdimarsdottir
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Psychology, Reyjavik University, Reyjavik, Iceland
| | - Andrea D Forman
- Department of Clinical Genetics, Risk Assessment Program, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Jessica Rispoli Joines
- Department of Medicine, Division of Hematology/Oncology, Marlene and Stewart Greenebaum Cancer Center, University of Maryland Medical Center, Baltimore, MD, USA
| | - Claire Davis
- Joan H. Marks Graduate Program in Human Genetics, Sarah Lawrence College, Yonkers, NY, USA
| | - Shelley R McCormick
- Center for Cancer Genetics and Prevention, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Wendy McKinnon
- Familial Cancer Program, University of Vermont Cancer Center, Burlington, VT, USA
| | - Kristi D Graves
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA
| | - Claudine Isaacs
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA
| | - Judy Garber
- Center for Cancer Genetics and Prevention, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Marie Wood
- Familial Cancer Program, University of Vermont Cancer Center, Burlington, VT, USA
| | - Lina Jandorf
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Marc D Schwartz
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
- Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA
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Otten E, Birnie E, Lucassen AM, Ranchor AV, Van Langen IM. Telemedicine uptake among Genetics Professionals in Europe: room for expansion. Eur J Hum Genet 2016; 24:157-63. [PMID: 25898928 PMCID: PMC4717205 DOI: 10.1038/ejhg.2015.83] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 03/25/2015] [Accepted: 03/27/2015] [Indexed: 11/09/2022] Open
Abstract
Today's economic challenges and the changing landscape of clinical genetics are forcing us to consider alternative ways of providing genetic services, to comply with budget limitations and at the same time meeting the demands of increasing patient numbers and patient-centered care delivery. Telegenetics could be an effective and efficient way of counseling, but its use in Europe is not widely reported, nor is there evidence of international collaboration. We conducted an online survey among 929 genetics professionals, to explore the current availability and use of different telegenetics modalities in Europe. Our questionnaire was completed by 104 clinically active European genetics professionals. Telephone genetic counseling was used by 17% of respondents. Videoconferencing facilities were available to 24%, but only 9% of them used these for patient counseling. Various barriers to availability and use were cited, ranging from practical constraints, lack of professional support/knowledge, to lack of perceived suitability and need. The results show that telegenetics modalities are not currently in widespread use by our respondents, in part due to perceived barriers. To meet the changing economic, genetic, and societal circumstances, we recommend consideration of greater integration of telegenetics into regular clinical genetic care, to supplement existing care modalities. Professional cooperation, sharing knowledge, and establishing guidelines on a national and international level could contribute to successful and more widespread implementation of telegenetics. However, the perceived practical and regulatory barriers have to be overcome.
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Affiliation(s)
- Ellen Otten
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Erwin Birnie
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Anneke M Lucassen
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Wessex Clinical Genetic Service, Southampton, UK
- Faculty of Medicine, Clinical Ethics and Law Unit, University of Southampton, Southampton, UK
| | - Adelita V Ranchor
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Irene M Van Langen
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Karlitz JJ, Hsieh MC, Liu Y, Blanton C, Schmidt B, Jessup JM, Wu XC, Chen VW. Population-Based Lynch Syndrome Screening by Microsatellite Instability in Patients ≤50: Prevalence, Testing Determinants, and Result Availability Prior to Colon Surgery. Am J Gastroenterol 2015; 110:948-55. [PMID: 25601013 DOI: 10.1038/ajg.2014.417] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES As there are no US population-based studies examining Lynch syndrome (LS) screening frequency by microsatellite instability (MSI) and immunohistochemistry (IHC), we seek to quantitate statewide rates in patients aged ≤50 years using data from a Centers for Disease Control and Prevention-funded Comparative Effectiveness Research (CER) project and identify factors associated with testing. Screening rates in this young, high-risk population may provide a best-case scenario as older patients, potentially deemed lower risk, may undergo testing less frequently. We also seek to determine how frequently MSI/IHC results are available preoperatively, as this may assist with decisions regarding colonic resection extent. METHODS Data from all Louisiana colorectal cancer (CRC) patients aged ≤50 years diagnosed in 2011 were obtained from the Louisiana Tumor Registry CER project. Registry researchers and physicians analyzed data, including pathology and MSI/IHC. RESULTS Of the 2,427 statewide all-age CRC patients, there were 274 patients aged ≤50 years, representing health care at 61 distinct facilities. MSI and/or IHC were performed in 23.0% of patients. Testing-associated factors included CRC family history (P<0.0045), urban location (P<0.0370), and care at comprehensive cancer centers (P<0.0020) but not synchronous/metachronous CRC or MSI-like histology. Public hospital screening was disproportionately low (P<0.0217). Of those tested, MSI and/or IHC was abnormal in 21.7%. Of those with abnormal IHC, staining patterns were consistent with LS in 87.5%. MSI/IHC results were available preoperatively in 16.9% of cases. CONCLUSIONS Despite frequently abnormal MSI/IHC results, LS screening in young, high-risk patients is low. Provider education and disparities in access to specialized services, particularly in underserved populations, are possible contributors. MSI/IHC results are infrequently available preoperatively.
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Affiliation(s)
- Jordan J Karlitz
- Division of Gastroenterology, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Mei-Chin Hsieh
- Louisiana Tumor Registry, Epidemiology Program, LSU Health Sciences Center School of Public Health, New Orleans, Louisiana, USA
| | - Yong Liu
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Christine Blanton
- Division of Gastroenterology, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Beth Schmidt
- Louisiana Tumor Registry, LSU Health Sciences Center School of Public Health, New Orleans, Louisiana, USA
| | - J Milburn Jessup
- Cancer Diagnosis Program-National Cancer Institute (NCI), Division of Cancer Treatment and Diagnosis (DCTD), National Institute of Health (NIH), Rockville, Maryland, USA
| | - Xiao-Cheng Wu
- Louisiana Tumor Registry, Epidemiology Program, LSU Health Sciences Center School of Public Health, New Orleans, Louisiana, USA
| | - Vivien W Chen
- Louisiana Tumor Registry, Epidemiology Program, LSU Health Sciences Center School of Public Health, New Orleans, Louisiana, USA
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Kinney AY, Butler KM, Schwartz MD, Mandelblatt JS, Boucher KM, Pappas LM, Gammon A, Kohlmann W, Edwards SL, Stroup AM, Buys SS, Flores KG, Campo RA. Expanding access to BRCA1/2 genetic counseling with telephone delivery: a cluster randomized trial. J Natl Cancer Inst 2014; 106:dju328. [PMID: 25376862 DOI: 10.1093/jnci/dju328] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The growing demand for cancer genetic services underscores the need to consider approaches that enhance access and efficiency of genetic counseling. Telephone delivery of cancer genetic services may improve access to these services for individuals experiencing geographic (rural areas) and structural (travel time, transportation, childcare) barriers to access. METHODS This cluster-randomized clinical trial used population-based sampling of women at risk for BRCA1/2 mutations to compare telephone and in-person counseling for: 1) equivalency of testing uptake and 2) noninferiority of changes in psychosocial measures. Women 25 to 74 years of age with personal or family histories of breast or ovarian cancer and who were able to travel to one of 14 outreach clinics were invited to participate. Randomization was by family. Assessments were conducted at baseline one week after pretest and post-test counseling and at six months. Of the 988 women randomly assigned, 901 completed a follow-up assessment. Cluster bootstrap methods were used to estimate the 95% confidence interval (CI) for the difference between test uptake proportions, using a 10% equivalency margin. Differences in psychosocial outcomes for determining noninferiority were estimated using linear models together with one-sided 97.5% bootstrap CIs. RESULTS Uptake of BRCA1/2 testing was lower following telephone (21.8%) than in-person counseling (31.8%, difference = 10.2%, 95% CI = 3.9% to 16.3%; after imputation of missing data: difference = 9.2%, 95% CI = -0.1% to 24.6%). Telephone counseling fulfilled the criteria for noninferiority to in-person counseling for all measures. CONCLUSIONS BRCA1/2 telephone counseling, although leading to lower testing uptake, appears to be safe and as effective as in-person counseling with regard to minimizing adverse psychological reactions, promoting informed decision making, and delivering patient-centered communication for both rural and urban women.
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Affiliation(s)
- Anita Y Kinney
- University of New Mexico Cancer Center, Cancer Control, Albuquerque, NM (AYK, K.M. Butler, KGF); Department of Internal Medicine, University of New Mexico, Albuquerque, NM (AYK); Huntsman Cancer Institute, (AYK, K.M. Boucher, LMP, AG, WK, SLE, AMS, SSB, RAC) and Department of Oncological Sciences (K.M. Boucher), University of Utah, Salt Lake City, UT; Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT (AYK, K.M. Boucher, SLE, AMS, SSB); Department of Oncology, Georgetown University Medical Center and Cancer Prevention and Control Program, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC (MDS, JSM); Department of Epidemiology, Rutgers Cancer Institute of New Jersey Rutgers University, New Brunswick, NJ (AMS).
| | - Karin M Butler
- University of New Mexico Cancer Center, Cancer Control, Albuquerque, NM (AYK, K.M. Butler, KGF); Department of Internal Medicine, University of New Mexico, Albuquerque, NM (AYK); Huntsman Cancer Institute, (AYK, K.M. Boucher, LMP, AG, WK, SLE, AMS, SSB, RAC) and Department of Oncological Sciences (K.M. Boucher), University of Utah, Salt Lake City, UT; Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT (AYK, K.M. Boucher, SLE, AMS, SSB); Department of Oncology, Georgetown University Medical Center and Cancer Prevention and Control Program, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC (MDS, JSM); Department of Epidemiology, Rutgers Cancer Institute of New Jersey Rutgers University, New Brunswick, NJ (AMS)
| | - Marc D Schwartz
- University of New Mexico Cancer Center, Cancer Control, Albuquerque, NM (AYK, K.M. Butler, KGF); Department of Internal Medicine, University of New Mexico, Albuquerque, NM (AYK); Huntsman Cancer Institute, (AYK, K.M. Boucher, LMP, AG, WK, SLE, AMS, SSB, RAC) and Department of Oncological Sciences (K.M. Boucher), University of Utah, Salt Lake City, UT; Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT (AYK, K.M. Boucher, SLE, AMS, SSB); Department of Oncology, Georgetown University Medical Center and Cancer Prevention and Control Program, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC (MDS, JSM); Department of Epidemiology, Rutgers Cancer Institute of New Jersey Rutgers University, New Brunswick, NJ (AMS)
| | - Jeanne S Mandelblatt
- University of New Mexico Cancer Center, Cancer Control, Albuquerque, NM (AYK, K.M. Butler, KGF); Department of Internal Medicine, University of New Mexico, Albuquerque, NM (AYK); Huntsman Cancer Institute, (AYK, K.M. Boucher, LMP, AG, WK, SLE, AMS, SSB, RAC) and Department of Oncological Sciences (K.M. Boucher), University of Utah, Salt Lake City, UT; Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT (AYK, K.M. Boucher, SLE, AMS, SSB); Department of Oncology, Georgetown University Medical Center and Cancer Prevention and Control Program, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC (MDS, JSM); Department of Epidemiology, Rutgers Cancer Institute of New Jersey Rutgers University, New Brunswick, NJ (AMS)
| | - Kenneth M Boucher
- University of New Mexico Cancer Center, Cancer Control, Albuquerque, NM (AYK, K.M. Butler, KGF); Department of Internal Medicine, University of New Mexico, Albuquerque, NM (AYK); Huntsman Cancer Institute, (AYK, K.M. Boucher, LMP, AG, WK, SLE, AMS, SSB, RAC) and Department of Oncological Sciences (K.M. Boucher), University of Utah, Salt Lake City, UT; Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT (AYK, K.M. Boucher, SLE, AMS, SSB); Department of Oncology, Georgetown University Medical Center and Cancer Prevention and Control Program, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC (MDS, JSM); Department of Epidemiology, Rutgers Cancer Institute of New Jersey Rutgers University, New Brunswick, NJ (AMS)
| | - Lisa M Pappas
- University of New Mexico Cancer Center, Cancer Control, Albuquerque, NM (AYK, K.M. Butler, KGF); Department of Internal Medicine, University of New Mexico, Albuquerque, NM (AYK); Huntsman Cancer Institute, (AYK, K.M. Boucher, LMP, AG, WK, SLE, AMS, SSB, RAC) and Department of Oncological Sciences (K.M. Boucher), University of Utah, Salt Lake City, UT; Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT (AYK, K.M. Boucher, SLE, AMS, SSB); Department of Oncology, Georgetown University Medical Center and Cancer Prevention and Control Program, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC (MDS, JSM); Department of Epidemiology, Rutgers Cancer Institute of New Jersey Rutgers University, New Brunswick, NJ (AMS)
| | - Amanda Gammon
- University of New Mexico Cancer Center, Cancer Control, Albuquerque, NM (AYK, K.M. Butler, KGF); Department of Internal Medicine, University of New Mexico, Albuquerque, NM (AYK); Huntsman Cancer Institute, (AYK, K.M. Boucher, LMP, AG, WK, SLE, AMS, SSB, RAC) and Department of Oncological Sciences (K.M. Boucher), University of Utah, Salt Lake City, UT; Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT (AYK, K.M. Boucher, SLE, AMS, SSB); Department of Oncology, Georgetown University Medical Center and Cancer Prevention and Control Program, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC (MDS, JSM); Department of Epidemiology, Rutgers Cancer Institute of New Jersey Rutgers University, New Brunswick, NJ (AMS)
| | - Wendy Kohlmann
- University of New Mexico Cancer Center, Cancer Control, Albuquerque, NM (AYK, K.M. Butler, KGF); Department of Internal Medicine, University of New Mexico, Albuquerque, NM (AYK); Huntsman Cancer Institute, (AYK, K.M. Boucher, LMP, AG, WK, SLE, AMS, SSB, RAC) and Department of Oncological Sciences (K.M. Boucher), University of Utah, Salt Lake City, UT; Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT (AYK, K.M. Boucher, SLE, AMS, SSB); Department of Oncology, Georgetown University Medical Center and Cancer Prevention and Control Program, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC (MDS, JSM); Department of Epidemiology, Rutgers Cancer Institute of New Jersey Rutgers University, New Brunswick, NJ (AMS)
| | - Sandra L Edwards
- University of New Mexico Cancer Center, Cancer Control, Albuquerque, NM (AYK, K.M. Butler, KGF); Department of Internal Medicine, University of New Mexico, Albuquerque, NM (AYK); Huntsman Cancer Institute, (AYK, K.M. Boucher, LMP, AG, WK, SLE, AMS, SSB, RAC) and Department of Oncological Sciences (K.M. Boucher), University of Utah, Salt Lake City, UT; Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT (AYK, K.M. Boucher, SLE, AMS, SSB); Department of Oncology, Georgetown University Medical Center and Cancer Prevention and Control Program, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC (MDS, JSM); Department of Epidemiology, Rutgers Cancer Institute of New Jersey Rutgers University, New Brunswick, NJ (AMS)
| | - Antoinette M Stroup
- University of New Mexico Cancer Center, Cancer Control, Albuquerque, NM (AYK, K.M. Butler, KGF); Department of Internal Medicine, University of New Mexico, Albuquerque, NM (AYK); Huntsman Cancer Institute, (AYK, K.M. Boucher, LMP, AG, WK, SLE, AMS, SSB, RAC) and Department of Oncological Sciences (K.M. Boucher), University of Utah, Salt Lake City, UT; Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT (AYK, K.M. Boucher, SLE, AMS, SSB); Department of Oncology, Georgetown University Medical Center and Cancer Prevention and Control Program, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC (MDS, JSM); Department of Epidemiology, Rutgers Cancer Institute of New Jersey Rutgers University, New Brunswick, NJ (AMS)
| | - Saundra S Buys
- University of New Mexico Cancer Center, Cancer Control, Albuquerque, NM (AYK, K.M. Butler, KGF); Department of Internal Medicine, University of New Mexico, Albuquerque, NM (AYK); Huntsman Cancer Institute, (AYK, K.M. Boucher, LMP, AG, WK, SLE, AMS, SSB, RAC) and Department of Oncological Sciences (K.M. Boucher), University of Utah, Salt Lake City, UT; Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT (AYK, K.M. Boucher, SLE, AMS, SSB); Department of Oncology, Georgetown University Medical Center and Cancer Prevention and Control Program, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC (MDS, JSM); Department of Epidemiology, Rutgers Cancer Institute of New Jersey Rutgers University, New Brunswick, NJ (AMS)
| | - Kristina G Flores
- University of New Mexico Cancer Center, Cancer Control, Albuquerque, NM (AYK, K.M. Butler, KGF); Department of Internal Medicine, University of New Mexico, Albuquerque, NM (AYK); Huntsman Cancer Institute, (AYK, K.M. Boucher, LMP, AG, WK, SLE, AMS, SSB, RAC) and Department of Oncological Sciences (K.M. Boucher), University of Utah, Salt Lake City, UT; Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT (AYK, K.M. Boucher, SLE, AMS, SSB); Department of Oncology, Georgetown University Medical Center and Cancer Prevention and Control Program, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC (MDS, JSM); Department of Epidemiology, Rutgers Cancer Institute of New Jersey Rutgers University, New Brunswick, NJ (AMS)
| | - Rebecca A Campo
- University of New Mexico Cancer Center, Cancer Control, Albuquerque, NM (AYK, K.M. Butler, KGF); Department of Internal Medicine, University of New Mexico, Albuquerque, NM (AYK); Huntsman Cancer Institute, (AYK, K.M. Boucher, LMP, AG, WK, SLE, AMS, SSB, RAC) and Department of Oncological Sciences (K.M. Boucher), University of Utah, Salt Lake City, UT; Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT (AYK, K.M. Boucher, SLE, AMS, SSB); Department of Oncology, Georgetown University Medical Center and Cancer Prevention and Control Program, Georgetown-Lombardi Comprehensive Cancer Center, Washington, DC (MDS, JSM); Department of Epidemiology, Rutgers Cancer Institute of New Jersey Rutgers University, New Brunswick, NJ (AMS)
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Beitsch PD, Whitworth PW. Can Breast Surgeons Provide Breast Cancer Genetic Testing? An American Society of Breast Surgeons Survey. Ann Surg Oncol 2014; 21:4104-8. [DOI: 10.1245/s10434-014-3711-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Indexed: 11/18/2022]
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