Reaching high-risk underserved individuals for cancer genetic counseling by video-teleconferencing

Abstract

Background Breast and colorectal cancers are common cancers for which genetic risk assessment and counseling are available. However, these services are often limited to metropolitan areas and are not readily accessible to underserved populations. Moreover, ethnic and racial disparities present additional obstacles to identifying and screening high-risk individuals and have a bearing on treatment outcomes. Objective To provide cancer genetic risk assessment and counseling through telemedicine to the remote, underserved primarily Hispanic population of the Texas-Mexico border region. Methods Program participants were mailed a questionnaire to assess their satisfaction with the program so that we could determine the acceptability of video-teleconferencing for cancer risk assessment. Results The overall level of satisfaction with the program was very high, demonstrating the acceptability of a cancer genetic risk assessment program that relied on telemedicine to reach and underserved minority community. Limitations Delivery model requires the availability of and access to communication technologies; trained staff are needed at remote sites for sample collection and patient handling. Conclusion Video-teleconferencing is an acceptable method of providing cancer risk assessment in a remote, underserved population.

Clinical models of telehealth in genetics: A regional telegenetics landscape

“…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, ). Some studies have shown reductions in cost and time per patient for the clinic and/or the patient (Buchanan et al, ; D'Agincourt‐Canning et al, ; Otten, Birnie, Ranchor, & van Langen, ; Schwartz et al, ; Weissman et al, ), shorter wait times (Cohen et al, ; Kubendran et al, ; Stalker et al, ; Weissman et al, ), and a larger geographic reach (Cohen et al, ).…”

“…access, genetic counseling, genetic services, rural, service delivery, telegenetics, telehealth, telemedicine, telephone counseling, underserved Fournier, Bazzell, & Dains, 2018;Gattas, MacMillan, Meinecke, Loane, & Wootton, 2001;Gray et al, 2000;Hardy & Grinzaid, 2017;Hawkins, Creighton, Ho, McManus, & Hayden, 2013;Hilgart et al, 2012;Hopper, Buckman, & Edwards, 2011;Kubendran, Sivamurthy, & Schaefer, 2017;Lea et al, 2005;Mette et al, 2016;Otten, Birnie, Lucassen, Ranchor, & van Langen, 2016;Schwartz et al, 2014;Solomons, Lamb, Lucas, McDonald, & Miesfeldt, 2018;Stalker et al, 2006;Sutphen et al, 2010;Weissman et al, 2018;Wenger et al, 2014;Zilliacus et al, 2011;Zilliacus, Meiser, Lobb, Kirk, et al, 2010). Some studies have shown reductions in cost and time per patient for the clinic and/or the patient (Buchanan et al, 2015;D'Agincourt-Canning et al, 2008;Otten, Birnie, Ranchor, & van Langen, 2016;Schwartz et al, 2014;Weissman et al, 2018), shorter wait times (Cohen et al, 2013;Kubendran et al, 2017;Stalker et al, 2006;Weissman et al, 2018), and a larger geographic reach (Cohen et al, 2013).…”

Logistics and Uptake of Genetic Testing for Patients Referred for Telegenetic Counselling for Cancer

“…Of the 119 survey respondents, 16% were found to have a pathogenic mutation and 10% were found to have a variant of uncertain significance (VUS). 6 However, this study did not delineate if there was a difference in the uptake of genetic testing between the patients seen for in-person genetic counselling versus those seen for telegenetic counselling. Bradbury et al (2016) evaluated patients who were offered telegenetic counselling for hereditary cancer at two remote sites.…”

“…1 Studies have shown that when telegenetic counselling services are compared to inperson genetic counselling, outcomes are similar in terms of patient satisfaction, anxiety, cancer worry, and knowledge. [2][3][4][5][6][7][8][9] Cancer centres that do not currently employ a genetic counsellor are encountering an increasing need to provide genetic counselling services at their centres, due to requirements for accreditation and from insurance companies. The Commission on Cancer and the National Accreditation Program for Breast Centres both require access to cancer risk assessment and testing when indicated for program accreditation.…”

“…In two studies the patients received telegenetic services at home. 6,18 In other instances, telegenetic counselling services were provided with the genetic counsellor on-site with the patient, and the clinical geneticist meeting remotely via videoconference. 8,9 The most common models, particularly in the United States, are those in which a genetic counsellor or clinical geneticist provides services via telegenetics to a patient at another healthcare facility, who may be either with or without support staff on-site with the patient.…”