Adapting genetic counseling operations amidst the COVID‐19 pandemic

Mauer, Caitlin; Zimmerman, John; Lahiri, Sayoni; Watson, Elise; Parsi, Lily; Berg, Jordan; Pirzadeh‐Miller, Sara

doi:10.1002/jgc4.1474

Cited by 10 publications

(7 citation statements)

References 19 publications

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“…Key barriers to address include comfort with and access to technology, reimbursement, co-ordination of sample collection for genetic testing, and privacy and ethical issues. In the virtual era of the COVID-19 pandemic, the importance of remote genetics care delivery, such as telegenetic visits, and remote sample collection, such as through mobile phlebotomy, have increased 79 , 80 . Finally, chatbots are also being studied in genetic education, consent and counselling delivery 81 .…”

Section: Genetics Care Deliverymentioning

confidence: 99%

Germline testing and genetic counselling in prostate cancer

Russo

Giri

2022

Nat Rev Urol

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Genetic testing for prostate cancer is rapidly growing and is increasingly being driven by precision medicine. Rates of germline pathogenic variants have been reported in up to 15% of men with prostate cancer, particularly in metastatic disease, and results of genetic testing could uncover options for precision therapy along with a spectrum of hereditary cancer-predisposition syndromes with unique clinical features that have complex management options. Thus, the pre-test discussion, whether delivered by genetic counsellors or by health-care professionals in hybrid models, involves information on hereditary cancer risk, extent of gene testing, purpose of testing, medical history and family history, potential types of results, additional cancer risks that might be uncovered, genetically based management and effect on families. Understanding precision medicine, personalized cancer risk management and syndrome-related cancer risk management is important in order to develop collaborative strategies with genetic counselling for optimal care of patients and their families.

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Section: Genetics Care Deliverymentioning

confidence: 99%

Germline testing and genetic counselling in prostate cancer

Russo

Giri

2022

Nat Rev Urol

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“…Telephone-and telehealth-based approaches have been found to be noninferior to inperson GC in patient-reported outcomes, such as satisfaction, anxiety, decisional conflict, and quality of life. [25][26][27][28][29] Our study provides evidence that remote-based germline testing is feasible for men with PCa, and is not associated with higher patient decisional conflict. Further study is needed regarding patient and provider perspectives, as there may be nuanced limitations, particularly regarding telephone counseling, such as distractions, condensed sessions, and less effective communication.…”

Section: Referred To Gts With a Diagnosis Of Pca (N = 906)mentioning

confidence: 64%

Implementation of a Telehealth Genetic Testing Station to Deliver Germline Testing for Men With Prostate Cancer

Kwon

Gordon

Tong

et al. 2023

JCO Oncology Practice

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PURPOSE: Germline testing for men with prostate cancer (PCa) poses numerous implementation barriers. Alternative models of care delivery are emerging, but implementation outcomes are understudied. We evaluated implementation outcomes of a hybrid oncologist– and genetic counselor–delivered model called the genetic testing station (GTS) created to streamline testing and increase access. METHODS: A prospective, single-institution, cohort study of men with PCa referred to the GTS from October 14, 2019, to October 14, 2021, was conducted. Using the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework, we described patients referred to GTS (Reach), the association of GTS with germline testing completion rates within 60 days of a new oncology appointment in a pre- versus post-GTS multivariable logistic regression (Effectiveness), Adoption, Implementation, and Maintenance. Because GTS transitioned from an on-site to remote service during the COVID-19 pandemic, we also compared outcomes for embedded versus remote GTS. RESULTS: Overall, 713 patients were referred to and eligible for GTS, and 592 (83%) patients completed germline testing. Seventy-six (13%) patients had ≥ 1 pathogenic variant. Post-GTS was independently associated with higher odds of completing testing within 60 days than pre-GTS (odds ratio, 8.97; 95% CI, 2.71 to 29.75; P < .001). Black race was independently associated with lower odds of testing completion compared with White race (odds ratio, 0.35; 95% CI, 0.13 to 0.96; P = .042). There was no difference in test completion rates or patient-reported decisional conflict for embedded versus remote GTS. GTS has been adopted by 31 oncology providers across four clinics, and implementation fidelity was high with low patient loss to follow-up, but staffing costs are a sustainability concern. CONCLUSION: GTS is a feasible, effective model for high-volume germline testing in men with PCa, both in person and using telehealth. GTS does not eliminate racial disparities in germline testing access.

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“…We anticipate health equity will likely increase with the use of Equity was also a motivator of telephone appointments becoming more widely accepted as billable visit types during the pandemic (Center for Connected Health Policy, 2021). Some healthcare systems widely or even preferentially used telephone appointments because they recognized video technologies would be prohibitive to their patient population (Mauer et al, 2021). Though telephone is more accessible to some patient populations, this should not prohibit the promotion of equal access for all telehealth modalities including telephone and video (Rodriguez, Betancourt, et al, 2021).…”

Section: Impact On Health Equitymentioning

confidence: 99%

“…Inability to collect a sample at the time of appointment introduces an additional barrier to test completion (Bergstrom et al, 2021). Lack of test completion and sample collection errors by patients at home (e.g., eating/drinking prior to collection, not getting enough sample, mislabeled or unclosed tubes) can lead to sample failure and delay test processing (Mauer et al, 2021).…”

Section: Feasibility and Implementationmentioning

confidence: 99%

An evidence‐based practice guideline of the National Society of Genetic Counselors for telehealth genetic counseling

Green

Hartzfeld²,

Terry³

et al. 2022

Journal of Genetic Counseling

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There are currently no practice guidelines available for genetic counseling using telehealth modalities. This evidence-based practice guideline was developed in response to increasing use of alternative service delivery models for genetic counseling, specifically telephone and video-based genetic counseling (telehealth genetic counseling or THGC). A recent systematic evidence review (SER) compared outcomes of THGC with in-person genetic counseling and found that for the majority of studied outcomes, THGC was a non-inferior and comparable service delivery model. The SER results were used to develop this guideline. The current and anticipated future use of THGC, including the influence of the COVID-19 pandemic, provides the context for this guideline. Recommendation: The Telehealth Practice Guideline author workgroup conditionally recommends telehealth genetic counseling, either via telephone or video, as a delivery method for genetic counseling. Depending on factors unique to individual healthcare systems and provider and patient populations, THGC may be the only service delivery model available or may be utilized in addition to other service delivery models including in-person genetic counseling. The evidence shows large desirable effects, minor undesirable effects, and increased equity for patients when THGC is available. THGC may reduce or remove existing barriers to patient access to genetic counseling, such as medical conditions and/or disabilities that may affect a patient's ability to travel, inflexible work or school schedules, and lack of reliable transportation, finances, or dependent care. THGC is likely acceptable to key groups impacted by its use and is feasible to implement. Certain patient populations may require additional resources or encounter more barriers in using telemedicine services in general.For these populations, THGC can still be a valuable option if solutions are available.

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Adapting genetic counseling operations amidst the COVID‐19 pandemic

Cited by 10 publications

References 19 publications

Germline testing and genetic counselling in prostate cancer

Germline testing and genetic counselling in prostate cancer

Implementation of a Telehealth Genetic Testing Station to Deliver Germline Testing for Men With Prostate Cancer

An evidence‐based practice guideline of the National Society of Genetic Counselors for telehealth genetic counseling

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