Delivery of cancer genetics services: The Royal Marsden telephone clinic model

Abstract

We have conducted a telelink telephone-led cancer genetic counselling model at The Royal Marsden NHS Foundation Trust. The study commenced in March 2004 and evaluation of the clinic was conducted over 17 months from March 2005 to the end of July 2006. A total of 612 patients had telephone consultations during this time, 228 of whom were referred from primary care with a median of 30 patients counselled per month (range of 19-63, depending on staff availability with average of two staff per clinic). Waiting times were measured for General Practitioner referrals and all 228 were counselled within the national target-stipulated 13 weeks (median 6 weeks, range 1-12). An additional 132 patients who were sent appointment letters after receipt of their family history questionnaires did not attend their appointments (18% of all potential referrals) and required recontacting by letter. After telephone counselling, 42% of patients were able to be discharged from the telephone clinic without a subsequent face-to-face appointment, thereby saving resources. The telephone clinic also had a short set-up time with flexibility on timing and day of administration, which would be an advantage in centres where outreach clinic facilities are scarce. The telelink telephone counselling model is highly efficient in triaging high risk individuals for face-to-face counselling as per the Kenilworth model, in effecting concentration of resources and in providing a flexible individual-centred approach to cancer genetic counselling delivery.

Identification of Genetic Counseling Service Delivery Models in Practice: A Report from the NSGC Service Delivery Model Task Force

“…This particular confusion stresses the need for clear definition and language when discussing SDM, which has been attempted in a prior publication from this group (Cohen et al 2012). We suspect that the use of telephone GC as a primary SDM may be lower than reported here, however recent literature is demonstrating increased use and acceptance of telephone genetic counseling (Bradbury et al 2011;Doughty Rice et al 2010;Graves et al 2010;Shanley et al 2007;Sutphen et al 2010).…”

Cluster-randomised non-inferiority trial comparing DVD-assisted and traditional genetic counselling in systematic population testing for BRCA1/2 mutations

“…While we have demonstrated a viable DVD-based model, other models are also being explored/developed. Telephone genetic counselling has been successfully used for triaging women from high-risk families for TC10 and disclosure of test result 9 30 31. Three RCTs compared telephone counselling to TC in high-risk women attending genetics clinics.…”

Telephone Genetic Counseling for High-Risk Women UndergoingBRCA1andBRCA2Testing: Rationale and Development of a Randomized Controlled Trial

“…Thus, anxious participants may have difficulty attending to and comprehending information presented over the telephone. Further, genetic counselors may be more attuned to anxiety or other distress cues during an in-person session; thus, they may have greater opportunity to recognize anxiety and appropriately intervene during in-person counseling (Shanley et al, 2007). We will also evaluate the possibility that telephone counseling may be more effective among participants with high levels of decisional conflict.…”

“…Shanley et al (2007) reported on their experience with 612 TGC consults through the Royal Marsden NHS Foundation Trust. Sessions were delivered in a timely, convenient manner for patients.…”