Randomized Noninferiority Trial of Telephone Delivery of <i>BRCA1/2</i> Genetic Counseling Compared With In-Person Counseling: 1-Year Follow-Up

Kinney, Anita Y.; Steffen, Laurie E.; Brumbach, Barbara H.; Kohlmann, Wendy; Du, Ruofei; Lee, Ji Hyun; Gammon, Amanda; Butler, Karin M.; Buys, Saundra S.; Stroup, Antoinette M.; Campo, Rebecca; Flores, Kristina G.; Mandelblatt, Jeanne S.; Schwartz, Marc D.

doi:10.1200/jco.2015.65.9557

Cited by 94 publications

(117 citation statements)

References 72 publications

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“…While face-toface counseling is the traditional clinical delivery model in genetic care, phone counseling has been used increasingly and has been found non-inferior to in-person counseling, at least for BRCA1/2 counseling and disclosure. 6,7 Further data are needed regarding outcomes for a broader range of genetic results and in the context of returning incidentally identified research results. Nonetheless, phone counseling is a practical approach that many are utilizing when face-to-face counseling is not feasible.…”

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confidence: 99%

Possible barriers for genetic counselors returning actionable genetic research results across state lines

Roberts

Wood

Gaieski

et al. 2017

Genetics in Medicine

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confidence: 99%

Possible barriers for genetic counselors returning actionable genetic research results across state lines

Roberts

Wood

Gaieski

et al. 2017

Genetics in Medicine

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“…We describe the Risk, Education, and Assessment for Cancer Hereditary (REACH) trial in detail elsewhere (5,10). Briefly, REACH was a family cluster randomized, two group, equivalency/non-inferiority trial comparing in-person to telephone counseling for women at high risk for BRCA1/2 mutations (NCT01346761).…”

Section: Methodsmentioning

confidence: 99%

“…To address access barriers, genetic counselors are increasingly using alternative counseling delivery methods such as telephone-based counseling (9). Our randomized controlled non-inferiority trial of in-person vs. telephone-based genetic counseling for breast and ovarian cancer survivors at increased hereditary cancer risk (REACH) found that telephone-based counseling was non-inferior on key patient-reported outcomes such as distress and decisional satisfaction (5,10). A secondary aim of the REACH trial was to examine factors associated with genetic testing decisions.…”

Section: Introductionmentioning

confidence: 99%

“…A secondary aim of the REACH trial was to examine factors associated with genetic testing decisions. However genetic testing uptake in REACH was low overall (~30%), with lower testing uptake among survivors receiving telephone-based counseling (5,10), suggesting the need to not only identify predictors of testing decisions, but to determine whether in-person vs. telephone-based counseling yielded different uptake depending on patient characteristics or patient perceptions of counseling.…”

Section: Introductionmentioning

confidence: 99%

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Genetic Testing in a Population-Based Sample of Breast and Ovarian Cancer Survivors from the REACH Randomized Trial: Cost Barriers and Moderators of Counseling Mode

Steffen

Gammon

et al. 2017

Cancer Epidemiology, Biomarkers &Amp; Prevention

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BACKGROUND This study evaluates predictors of BRCA1/2 testing among breast and ovarian cancer survivors who received genetic counseling as part of a randomized trial and evaluates moderators of counseling mode on testing uptake. METHODS Predictors of BRCA1/2 testing within 1-year post-counseling were evaluated using multivariable logistic regression in a population-based sample of breast and ovarian cancer survivors at increased hereditary risk randomly assigned to in-person (IPC; n = 379) vs. telephone counseling (TC; n = 402). Variables that moderated the association between counseling mode and testing were identified by subgroup analysis. RESULTS Testing uptake was associated with higher perceived comparative mutation risk (OR = 1.32, 95% CI = 1.11, 1.57) in the adjusted analysis. Those without cost barriers had higher testing uptake (OR = 18.73, 95% CI = 7.09, 49.46). Psychological distress and perceived comparative mutation risk moderated the effect of counseling and testing. Uptake between IPC vs. TC did not differ at low levels of distress and risk, but differed at high distress (26.3% TC vs. 44.3% IPC) and high perceived comparative risk (33.9% TC vs. 50.5% IPC). CONCLUSIONS Cost concerns are a strong determinant of testing. Differences in testing uptake by counseling mode may depend on pre-counseling distress and risk perceptions. IMPACT Cost concerns may contribute to low testing in population-based samples of at risk cancer survivors. Pre-counseling psychosocial characteristics should be considered when offering in-person vs. telephone counseling.

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“…139 In fact, telephone genetic counseling has been successfully used to increase reach and access to CGRA among a geographically diverse sample of high-risk women, without long-term adverse psychosocial consequences. 43, 140, 141 Furthermore, results from prior studies have demonstrated that telephone genetic counseling may lead to cost savings compared to in person sessions. 141, 142 In parallel, academic medical centers and commercial companies have increasingly started to offer telephone genetic testing options to increase the reach of CGRA services while improving accessibility.…”

Section: Community- and Policy-level Considerations In Genetic Tesmentioning

confidence: 99%

Care delivery considerations for widespread and equitable implementation of inherited cancer predisposition testing

Cragun

Kinney

Pal

2016

Expert Review of Molecular Diagnostics

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Introduction DNA sequencing advances through next-generation sequencing (NGS) and several practice changing events, have led to shifting paradigms for inherited cancer predisposition testing. These changes necessitated a means by which to maximize health benefits without unnecessarily inflating healthcare costs and exacerbating health disparities. Areas covered NGS-based tests encompass multi-gene panel tests, whole exome sequencing, and whole genome sequencing, all of which test for multiple genes simultaneously, compared to prior sequencing practices through which testing was performed sequentially for one or two genes. Taking an ecological approach, this article synthesizes the current literature to consider the broad impact of these advances from the individual patient-, interpersonal-, organizational-, community- and policy-levels. Furthermore, the authors describe how multi-level factors that impact genetic testing and follow-up care reveal great potential to widen existing health disparities if these issues are not addressed. Expert Commentary As we consider ways to maximize patient benefit from testing in a cost effective manner, it is important to consider perspectives from multiple levels. This information is needed to guide the development of interventions such that the promise of genomic testing may be realized by all populations, regardless of race, ethnicity and ability to pay.

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Randomized Noninferiority Trial of Telephone Delivery of BRCA1/2 Genetic Counseling Compared With In-Person Counseling: 1-Year Follow-Up

Cited by 94 publications

References 72 publications

Possible barriers for genetic counselors returning actionable genetic research results across state lines

Possible barriers for genetic counselors returning actionable genetic research results across state lines

Genetic Testing in a Population-Based Sample of Breast and Ovarian Cancer Survivors from the REACH Randomized Trial: Cost Barriers and Moderators of Counseling Mode

Care delivery considerations for widespread and equitable implementation of inherited cancer predisposition testing

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