Comparison of Telephone and Televideo Modes for Delivery of Genetic Counseling: a Randomized Trial

Abstract

Telephone and televideo have yielded equivalent patient satisfaction and psychosocial outcomes when compared to in-person genetic counseling, yet little is known about how they compare to one another. In this randomized controlled trial, veterans received genetic counseling via telephone or traveled to a clinic to participate via encrypted televideo. Knowledge and visit satisfaction were assessed 2 weeks later. Travel time, mileage, and out-of-pocket costs were calculated for videoconferencing. Qualitative interviews were conducted with patients and counselors to assess acceptability. Of the 20 male patients randomized to telephone, 90% received counseling and provided outcomes; of the 18 randomized to televideo, 67% received counseling and 50% provided outcomes. Telephone patients answered a mean of 4.4 of eight questions correctly at baseline and 4.7 at follow-up; televideo means were 5.6 and 6.5, respectively. Satisfaction was 25.2 out of 30 for telephone and 26.9 for televideo. Televideo patients incurred a median of 2.8 h of travel time, 40 roundtrip miles, and $67.29 in costs. Patients and counselors found both modes acceptable for providing education and answering questions. Although patients liked the flexibility of telephone, counselors felt patients missed more appointments and were distracted when using telephone. A noted advantage of videoconferencing was reading body language. Further evaluation of alternative delivery modes is needed.

Clinical models of telehealth in genetics: A regional telegenetics landscape

“…Further, some studies have suggested similar outcomes when comparing telephone consultations to in-person care (Buchanan et al, 2016;Chang et al, 2016;Fournier et al, 2018;Jacobs et al, 2016), and to video consultations (Voils et al, 2017). Some data also suggest that patients prefer, or are willing to utilize, telephone consultations more so than video consultations (Hardy & Grinzaid, 2017;Voils et al, 2017). However, providers continue to express concerns about whether telephone consultations can provide appropriate psychosocial care and education to patients (Bradbury et al, 2011;Burgess, Carmany, & Trepanier, 2016;Cohen et al, 2016), and the lack of physical exams and limitations on billing in telephone models are further barriers, as our data reflect.…”

“…Some definitions place telephone consultations into another distinct (non-telegenetics) category (Cohen et al, 2013;Hilgart, Hayward, Coles, & Iredale, 2012). However, other works, including previous work of the RGNs, have included telephone consultations under the "telegenetics" umbrella (Voils, Venne, Weidenbacher, Sperber, & Datta, 2017). Although the NSGC Professional Status Survey separates telephone visits from webbased/video visits, it does not use the term "telegenetics" at all (National Society of Genetic Counselors, 2016).…”

“…When examining the literature specific to genetics consultation via live videoconferencing, the term "telegenetics," is most often used, but the terms "virtual health" (Weissman, Zellmer, Gill, & Wham, 2018), "televideo" (Voils et al, 2017), and web-based/video (National Society of Genetic Counselors, 2016) were also noted.…”

“…When examining the literature specific to genetics consultation via live videoconferencing, the term “telegenetics,” is most often used, but the terms “virtual health” (Weissman, Zellmer, Gill, & Wham, 2018), “televideo” (Voils et al, ), and web‐based/video (National Society of Genetic Counselors, ) were also noted. Collectively, these studies have demonstrated improved access to care in underserved areas with high levels of patient satisfaction and outcomes similar to in‐person consultations across many patient populations and medical indications (Abrams & Geier, ; Bradbury et al, ; Buchanan et al, ; Coelho, Arnold, Nayler, Tischkowitz, & MacKay, ; D'Agincourt‐Canning et al, ; Fournier, Bazzell, & Dains, ; Gattas, MacMillan, Meinecke, Loane, & Wootton, ; Gray et al, ; Hardy & Grinzaid, ; Hawkins, Creighton, Ho, McManus, & Hayden, ; Hilgart et al, ; Hopper, Buckman, & Edwards, ; Kubendran, Sivamurthy, & Schaefer, ; Lea et al, ; Mette et al, ; Otten, Birnie, Lucassen, Ranchor, & van Langen, ; Schwartz et al, ; Solomons, Lamb, Lucas, McDonald, & Miesfeldt, ; Stalker et al, ; Sutphen et al, ; Weissman et al, ; Wenger et al, ; Zilliacus et al, ; Zilliacus, Meiser, Lobb, Kirk, et al, ).…”

Genetic counselor training for the next generation: Where do we go from here?

“…Genetic counselors have reported implementing alternative service delivery models to reduce wait times and to enhance access to care (Cohen, Huziak, Gustafson, & Grubs, ). Recently, randomized control studies have been conducted to compare a number of outcomes for various service delivery models (Biesecker et al, ; Buchanan et al, ; Voils, Venne, Weidenbacher, Sperber, & Datta, ). Educational components of genetic counseling are becoming automated with the implementation of videos, online educational tools, and decision aids that are used in some clinics to handle the increased demand for testing (Axilbund, Hamby, Thompson, Olsen, & Griffin, ; Birch et al, ).…”