1
|
Saylor KW, Fernandes EQ, Adams M, Paraghamian S, Shalowitz DI. Predictors of germline genetic testing referral and completion in ovarian cancer patients at a Comprehensive Cancer Center. Gynecol Oncol 2024; 186:53-60. [PMID: 38599112 DOI: 10.1016/j.ygyno.2024.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 03/26/2024] [Accepted: 03/30/2024] [Indexed: 04/12/2024]
Abstract
OBJECTIVES To identify predictors of referral and completion of germline genetic testing among newly diagnosed ovarian cancer patients, with a focus on geographic social deprivation, oncologist-level practices, and time between diagnosis and completion of testing. METHODS Clinical and sociodemographic data were abstracted from medical records of patients newly diagnosed with ovarian cancer between 2014 and 2019 in the University of North Carolina Health System. Factors associated with referral for genetic counseling, completion of germline testing, and time between diagnosis and test results were identified using multivariable regression. RESULTS 307/459 (67%) patients were referred for genetic counseling and 285/459 (62%) completed testing. The predicted probability of test completion was 0.83 (95% CI: 0.77-0.88) for patients with a referral compared to 0.27 (95% CI: 0.18-0.35) for patients without a referral. The predicted probability of referral was 0.75 (95% CI: 0.69-0.82) for patients at the 25th percentile of ZIP code-level Social Deprivation Index (SDI) and 0.67 (0.60-0.74) for patients at the 75th percentile of SDI. Referral varied by oncologist, with predicted probabilities ranging from 0.47 (95% CI: 0.32-0.62) to 0.93 (95% CI: 0.85-1.00) across oncologists. The median time between diagnosis and test results was 137 days (IQR: 55-248 days). This interval decreased by a predicted 24.46 days per year (95% CI: 37.75-11.16). CONCLUSIONS We report relatively high germline testing and a promising trend in time from diagnosis to results, with variation by oncologist and patient factors. Automated referral, remote genetic counseling and sample collection, reduced out-of-pocket costs, and educational interventions should be explored.
Collapse
Affiliation(s)
- Katherine W Saylor
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, PA, United States of America.
| | - Elizabeth Q Fernandes
- University of North Carolina School of Medicine, Chapel Hill, NC, United States of America
| | - Michael Adams
- Division of Pediatric Genetics and Metabolism, University of North Carolina School of Medicine, Chapel Hill, PA, United States of America
| | - Sarah Paraghamian
- Department of Obstetrics and Gynecology, Tufts University School of Medicine, Boston, MA, United States of America
| | - David I Shalowitz
- Michigan Cancer Center, Kalamazoo, MI, United States of America; Collaborative on Equity in Rural Cancer Care, Kalamazoo, MI, United States of America
| |
Collapse
|
2
|
Gostic N, Groepper D, Trinkle-Tucker M, Johnson M, Niendorf KB. An examination of psychosocial and professional effects of the COVID-19 pandemic on genetic counselors. J Genet Couns 2024; 33:269-280. [PMID: 37096772 DOI: 10.1002/jgc4.1721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 03/29/2023] [Accepted: 04/08/2023] [Indexed: 04/26/2023]
Abstract
For healthcare workers, recognized professional challenges associated with the COVID-19 pandemic include changes to service delivery models, increased burnout, furlough, and loss of income. The main goal of this study was to more clearly define the impact on mental health and quality of life of genetic counselors during the COVID-19 pandemic in the contexts of their personal, professional, and social lives. Eligible genetic counselors (GCs) (n = 283) responded to an online survey that incorporated validated instruments: Patient Health Questionnaire, Generalized Anxiety Disorder, Professional Quality of Life, and the In Charge Financial Distress/Financial Well-Being Scale. Additionally, original questions were developed from previous qualitative research on COVID-19 challenges for healthcare workers. Results showed 62% of respondents felt their mental health was impacted for the worse, 45% found it more difficult to achieve work/life balance, 16.8% scored within moderate-to-severe depression severity, 19.2% scored within moderate-to-severe anxiety, 26.3% reported high burnout, and 7% had high financial distress. GCs reported generally lower levels of anxiety and depression compared to healthcare workers and the general population. Thematic analysis identified feelings of isolation and difficulties balancing professional/personal responsibilities with more remote work. However, some participants reported greater flexibility in their schedule and more time with family. Self-care activities increased, with 93% engaging in more meditation and 54% began exercising. There were similar themes reported in this survey compared to other healthcare workers' experiences. There is also a dichotomy in positive and negative impacts with some GCs appreciating the flexibility of working from home but others reporting this blurs the line between personal and professional responsibilities. These results suggest consequences of the COVID-19 pandemic will continue to impact the field of genetic counseling and understanding these changes will be instrumental in addressing the needs of GCs to practice effectively.
Collapse
Affiliation(s)
- Nicole Gostic
- Genetic Counseling Program, Indiana State University, Terre Haute, Indiana, USA
- Charles A. Sammons Cancer Center, Baylor Scott and White Health, Dallas, Texas, USA
| | - Daniel Groepper
- Department of Pediatrics, SIU School of Medicine, Springfield, Illinois, USA
| | - Megan Trinkle-Tucker
- Genetic Counseling Program, Indiana State University, Terre Haute, Indiana, USA
- Genetic Counseling Program, Bay Path University, Longmeadow, Massachusetts, USA
| | - Malynnda Johnson
- Genetic Counseling Program, Indiana State University, Terre Haute, Indiana, USA
| | - Kristin B Niendorf
- Genetic Counseling Program, Indiana State University, Terre Haute, Indiana, USA
| |
Collapse
|
3
|
Temares DS, Liang LW, Bergner AL, Reilly MP, Kalia I. Patient experiences in receiving telegenetics care for inherited cardiovascular diseases. J Community Genet 2024; 15:119-127. [PMID: 38095830 PMCID: PMC11031528 DOI: 10.1007/s12687-023-00693-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 12/05/2023] [Indexed: 04/20/2024] Open
Abstract
Telegenetics played an important role in providing genetic services to patients during the COVID-19 pandemic. In particular, at our institution, it enabled us to expand our genetic counseling and testing services to non-local family members of patients outside of our prior catchment area. However, as telegenetics continues to be utilized even as social distancing is no longer required, further information is needed regarding the impact of this modality on patient experience within cardiogenetics. This study qualitatively explored the experiences of 12 genotype positive individuals who underwent genetic counseling and testing via telegenetics during the first 22 months of the COVID-19 pandemic and compared the experiences of local vs. non-local patients. Both local and non-local participants discussed similar benefits and drawbacks to the use of technology in telegenetics and overall found the use of telegenetics and at-home genetic testing to be convenient. Both groups also noted having to make changes in their daily lives and future planning as a consequence of the positive genetic testing results. However, access to follow-up care differed between local and non-local participants, with more local participants having scheduled and attended appointments with the appropriate medical providers compared to non-local participants. Supplying non-local patients access to remote cardiogenetic testing may therefore require careful consideration in how to ensure proper follow-up care for genotype positive patients and may necessitate the involvement of national professional or patient-centered organizations to help streamline the referral process.
Collapse
Affiliation(s)
- Dani S Temares
- Genetic Counseling Graduate Program, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Lusha W Liang
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Amanda L Bergner
- Genetic Counseling Graduate Program, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Genetics and Development, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Muredach P Reilly
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Irving Institute for Clinical and Translational Research, Columbia University Irving Medical Center, New York, NY, USA
| | - Isha Kalia
- Division of Hematology and Oncology, George Washington University Medical Faculty Associates, 2150 Pennsylvania Ave NW, G-414, Washington, DC, 20037, USA.
| |
Collapse
|
4
|
Kessler LJ, Mundt M, Freiberg Y, Taylor L, Valverde KD. Telesupervision in genetic counseling education during COVID-19 and beyond. J Genet Couns 2024. [PMID: 38185868 DOI: 10.1002/jgc4.1845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 11/10/2023] [Accepted: 11/26/2023] [Indexed: 01/09/2024]
Abstract
The COVID-19 pandemic led healthcare organizations to pivot to telemedicine, precipitating the shift to telesupervision, defined as supervision over video-conferencing platforms and telephone, for genetic counseling students. This study aimed to (1) characterize the impact of the COVID-19 pandemic on genetic counseling supervision, (2) ascertain genetic counseling supervisor experiences with telesupervision, and (3) examine the association between years of genetic counseling experience and preferences related to supervision modality. Certified genetic counselors were recruited through the National Society of Genetic Counselors (NSGC), Pennsylvania Association of Genetic Counselors (PAGC), and Association of Genetic Counseling Program Directors (AGCPD) listservs and by purposive sampling via emails to Genetic Counseling Program Directors in program-rich regions. An investigator-created survey was administered online to elicit descriptions of supervision during the pandemic, including modifications to rotations, changes to the number of students supervised, and mode of supervision preference. The survey was completed by 122 genetic counselors. The 54-question survey included multiple-choice, ranking, and open-ended questions. The majority (95.9%) of the participants were female, with an average age of 32 years. Most (86%) of participants reported changes in their supervision practices due to COVID-19, including sole use of telesupervision (54.4%), decreases in rotation lengths (25.4%), and delays in rotation start dates (24.6%). Interestingly, 19.3% (22/114) supervised more students than before the pandemic, and 18.4% (21/114) of participants supervised fewer students. Approximately two thirds (67.5%) of supervisors preferred supervising students in-person, while 2.6% preferred telesupervision, and 29.8% had no preference. Those who preferred to supervise in-person had fewer years of experience than those who had no preference (median = 4 years vs. median = 7 years respectively, Wilcoxonp-value = 0.0418, effect size rpb = 0.19, small). Given the persistence of telemedicine beyond the pandemic, telesupervision may be necessary to train genetic counseling students. However, additional research is needed to determine the effectiveness of telesupervision in facilitating student skill development and attainment of the Accreditation Council for Genetic Counseling (ACGC) Practice-Based Competencies (PBCs).
Collapse
Affiliation(s)
- Lisa Jay Kessler
- Master of Science in Genetic Counseling Program, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michaela Mundt
- Master of Science in Genetic Counseling Program, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yael Freiberg
- Master of Science in Genetic Counseling Program, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lynne Taylor
- Center for Clinical Epidemiology and Biostatistics, Biostatistics Analysis Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kathleen D Valverde
- Master of Science in Genetic Counseling Program, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|
5
|
Martinez JM, Zinberg RE, Diaz GA, Naik H. Patient and Provider Experiences and Views on the Use of Telehealth in Genetics Clinics in Response to the COVID-19 Pandemic. Telemed J E Health 2024; 30:118-125. [PMID: 37294555 DOI: 10.1089/tmj.2023.0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
Abstract
Introduction: The 2019 Coronavirus Disease (COVID-19) pandemic necessitated a mass transition in genetics clinics nationwide from in-person care to virtual care through telehealth. Before the COVID-19 pandemic, there was limited research on the use of telehealth in genetics specialties. Therefore, the COVID-19 pandemic presented a unique opportunity to study this emerging mode of care delivery in the setting of genetics clinics. This study described the scope of telehealth use in genetics clinics nationally and determined how COVID-19 influenced patients' decisions regarding their genetic care. Methods: Two anonymous surveys for patients and providers were developed. The patient survey was offered online to all genetics patients seen through telehealth at a Manhattan-based practice between March and December 2020. The provider survey was distributed through several listservs to genetics providers nationwide. Results: Patients (n = 242) and providers (n = 150) responded. Telehealth was used in all specialty genetics clinics for both initial and follow-up visits. Telehealth was both effective and satisfactory to patients for both visit types and across specialties; however, Asian and Hispanic/Latino patients had significantly lower mean satisfaction scores compared with White patients (p = 0.03 and 0.04, respectively). Patients appreciated telehealth for its convenience and to avoid COVID-19 exposure. Providers across specialties and provider types preferred telehealth for follow-up rather than initial visits. Several clinic initiatives related to telehealth were identified. Discussion: Telehealth was generally well received by both patients and providers, and is expected to become permanent option in genetics clinics. Further studies are needed to identify barriers to accessing telehealth.
Collapse
Affiliation(s)
- Julia M Martinez
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Division of Genetic Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Randi E Zinberg
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - George A Diaz
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Hetanshi Naik
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| |
Collapse
|
6
|
Lichten L, Murden R, Ali N, Bellcross C. Genetic counselors' perceptions of student supervision across service delivery models. J Genet Couns 2023; 32:1314-1324. [PMID: 37095650 DOI: 10.1002/jgc4.1711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 02/26/2023] [Accepted: 03/13/2023] [Indexed: 04/26/2023]
Abstract
Genetic counseling (GC) services are increasingly delivered by phone or video, resulting in more telehealth student rotations. The purpose of this study was to describe genetic counselors' utilization of telehealth for student supervision and to compare how their comfort, preferences, and perception of the difficulty of selected student supervision competencies vary between phone, video, and in-person student supervision. In 2021, patient-facing genetic counselors in North America with ≥1-year GC experience who supervised ≥3 GC students in the last 3 years received an invitation via the American Board of Genetic Counseling or the Association of GC Program Directors listservs to complete a 26-item online questionnaire. There were 132 responses eligible for analysis. Demographics were fairly consistent with the National Society of Genetic Counselors Professional Status Survey. The majority of participants used more than one service delivery model to provide GC services (93%) and supervise students (89%). Six supervisory competencies related to the student-supervisor communication (Eubanks HIggins et al., 2013) were perceived to be most difficult to accomplish by phone and easiest in-person (p < 0.0001). Participants were most comfortable in-person and least comfortable by telephone for both patient care and student supervision (p < 0.001). The majority of participants predicted continued use of telehealth for patient care but preferred in-person service delivery for both patient care (66%) and student supervision (81%). Overall, these findings indicate service delivery model changes in the field have an impact on GC education and suggest that the student-supervisor relationship may be different via telehealth. Furthermore, the stronger preference for in-person patient care and student supervision, despite predicted continued telehealth utilization, points to a need for multifaceted telehealth education initiatives.
Collapse
Affiliation(s)
- Lauren Lichten
- Department of Human Genetics, School of Medicine, Emory University, Atlanta, Georgia, 30322, USA
| | - Raphiel Murden
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, 30322, USA
| | - Nadia Ali
- Department of Human Genetics, School of Medicine, Emory University, Atlanta, Georgia, 30322, USA
| | - Cecelia Bellcross
- Department of Human Genetics, School of Medicine, Emory University, Atlanta, Georgia, 30322, USA
| |
Collapse
|
7
|
Sebastin M, Odgis JA, Suckiel SA, Bonini KE, Di Biase M, Brown K, Marathe P, Kelly NR, Ramos MA, Rodriguez JE, Aguiñiga KL, Lopez J, Maria E, Rodriguez MA, Yelton NM, Cunningham-Rundles C, Gallagher K, McDonald TV, McGoldrick PE, Robinson M, Rubinstein A, Shulman LH, Wolf SM, Yozawitz E, Zinberg RE, Abul-Husn NS, Bauman LJ, Diaz GA, Ferket BS, Greally JM, Jobanputra V, Gelb BD, Horowitz CR, Kenny EE, Wasserstein MP. The TeleKidSeq pilot study: incorporating telehealth into clinical care of children from diverse backgrounds undergoing whole genome sequencing. Pilot Feasibility Stud 2023; 9:47. [PMID: 36949526 PMCID: PMC10031704 DOI: 10.1186/s40814-023-01259-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 02/02/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic forced healthcare institutions and many clinical research programs to adopt telehealth modalities in order to mitigate viral spread. With the expanded use of telehealth, there is the potential to increase access to genomic medicine to medically underserved populations, yet little is known about how best to communicate genomic results via telehealth while also ensuring equitable access. NYCKidSeq, a multi-institutional clinical genomics research program in New York City, launched the TeleKidSeq pilot study to assess alternative forms of genomic communication and telehealth service delivery models with families from medically underserved populations. METHODS We aim to enroll 496 participants between 0 and 21 years old to receive clinical genome sequencing. These individuals have a neurologic, cardiovascular, and/or immunologic disease. Participants will be English- or Spanish-speaking and predominantly from underrepresented groups who receive care in the New York metropolitan area. Prior to enrollment, participants will be randomized to either genetic counseling via videoconferencing with screen-sharing or genetic counseling via videoconferencing without screen-sharing. Using surveys administered at baseline, results disclosure, and 6-months post-results disclosure, we will evaluate the impact of the use of screen-sharing on participant understanding, satisfaction, and uptake of medical recommendations, as well as the psychological and socioeconomic implications of obtaining genome sequencing. Clinical utility, cost, and diagnostic yield of genome sequencing will also be assessed. DISCUSSION The TeleKidSeq pilot study will contribute to innovations in communicating genomic test results to diverse populations through telehealth technology. In conjunction with NYCKidSeq, this work will inform best practices for the implementation of genomic medicine in diverse, English- and Spanish-speaking populations.
Collapse
Affiliation(s)
- Monisha Sebastin
- Department of Pediatrics, Division of Pediatric Genetic Medicine, Children's Hospital at Montefiore/Montefiore Medical Center/Albert Einstein College of Medicine, 3411 Wayne Ave, 9th Floor, Bronx, NY, 10467, USA
| | - Jacqueline A Odgis
- The Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sabrina A Suckiel
- The Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Katherine E Bonini
- The Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Miranda Di Biase
- Department of Pediatrics, Division of Pediatric Genetic Medicine, Children's Hospital at Montefiore/Montefiore Medical Center/Albert Einstein College of Medicine, 3411 Wayne Ave, 9th Floor, Bronx, NY, 10467, USA
| | - Kaitlyn Brown
- Department of Pediatrics, Division of Pediatric Genetic Medicine, Children's Hospital at Montefiore/Montefiore Medical Center/Albert Einstein College of Medicine, 3411 Wayne Ave, 9th Floor, Bronx, NY, 10467, USA
| | - Priya Marathe
- The Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nicole R Kelly
- Department of Pediatrics, Division of Pediatric Genetic Medicine, Children's Hospital at Montefiore/Montefiore Medical Center/Albert Einstein College of Medicine, 3411 Wayne Ave, 9th Floor, Bronx, NY, 10467, USA
| | - Michelle A Ramos
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jessica E Rodriguez
- The Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Karla López Aguiñiga
- The Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jessenia Lopez
- Department of Pediatrics, Division of Pediatric Genetic Medicine, Children's Hospital at Montefiore/Montefiore Medical Center/Albert Einstein College of Medicine, 3411 Wayne Ave, 9th Floor, Bronx, NY, 10467, USA
| | - Estefany Maria
- Department of Pediatrics, Division of Pediatric Genetic Medicine, Children's Hospital at Montefiore/Montefiore Medical Center/Albert Einstein College of Medicine, 3411 Wayne Ave, 9th Floor, Bronx, NY, 10467, USA
| | - Michelle A Rodriguez
- The Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nicole M Yelton
- The Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Charlotte Cunningham-Rundles
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Katie Gallagher
- Department of Pediatrics, Division of Pediatric Genetic Medicine, Children's Hospital at Montefiore/Montefiore Medical Center/Albert Einstein College of Medicine, 3411 Wayne Ave, 9th Floor, Bronx, NY, 10467, USA
| | - Thomas V McDonald
- Department of Medicine (Cardiology), Montefiore/Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Patricia E McGoldrick
- Department of Pediatrics, Division of Child Neurology, New York Medical College, Valhalla, NY, USA
- Pediatric Neurology, Boston Children's Health Physicians/Maria Fareri Children's Hospital, Hawthorne, NY, USA
| | | | - Arye Rubinstein
- Department of Allergy and Immunology, Children's Hospital at Montefiore/Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Lisa H Shulman
- Department of Pediatrics, Division of Developmental Medicine, Rose F. Kennedy Children's Evaluation & Rehabilitation Center at Children's Hospital at Montefiore/Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Steven M Wolf
- Department of Pediatrics, Division of Child Neurology, New York Medical College, Valhalla, NY, USA
- Pediatric Neurology, Boston Children's Health Physicians/Maria Fareri Children's Hospital, Hawthorne, NY, USA
| | - Elissa Yozawitz
- Isabelle Rapin Division of Child Neurology of the Saul R Korey Department of Neurology at Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Pediatrics, Children's Hospital at Montefiore/Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Randi E Zinberg
- Department of Genetics and Genomic Sciences , Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Noura S Abul-Husn
- The Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Genetics and Genomic Sciences , Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Laurie J Bauman
- Department of Pediatrics, Division of Ambulatory Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA
| | - George A Diaz
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Genetics and Genomic Sciences , Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bart S Ferket
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - John M Greally
- Department of Pediatrics, Division of Pediatric Genetic Medicine, Children's Hospital at Montefiore/Montefiore Medical Center/Albert Einstein College of Medicine, 3411 Wayne Ave, 9th Floor, Bronx, NY, 10467, USA
| | - Vaidehi Jobanputra
- Molecular Diagnostics, New York Genome Center, New York, NY, USA
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, NY, USA
| | - Bruce D Gelb
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Genetics and Genomic Sciences , Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Carol R Horowitz
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Eimear E Kenny
- The Institute for Genomic Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Genetics and Genomic Sciences , Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Melissa P Wasserstein
- Department of Pediatrics, Division of Pediatric Genetic Medicine, Children's Hospital at Montefiore/Montefiore Medical Center/Albert Einstein College of Medicine, 3411 Wayne Ave, 9th Floor, Bronx, NY, 10467, USA.
| |
Collapse
|
8
|
Douglas TC, May C, Dent K, Carey JC, Mladucky J. Prenatal patient perceptions of receiving difficult news over the telephone. J Genet Couns 2023. [PMID: 36843230 DOI: 10.1002/jgc4.1694] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 02/05/2023] [Accepted: 02/08/2023] [Indexed: 02/28/2023]
Abstract
Difficult news has been described as any news that adversely and seriously affects an individual's view of their future. Research in oncology genetic counseling demonstrated that individuals do not prefer in-person or telephone delivery of their genetic test results. However, in the prenatal setting, there is limited research examining how patients prefer news related to their pregnancies be disclosed. This study aimed to assess the experiences and preferences of prenatal patients who received difficult news by telephone. A semi-structured interview guide was developed to assess patients' personal definitions of difficult news and their experiences receiving the news by telephone. Fifteen patients seen prenatally by a genetic counselor were interviewed. Interviews were transcribed and consensus-coded, using inductive content analysis to identify several themes. The most common definition of difficult news included unexpected, life-changing, or devastating information. Participants described aspects of their experience and strategies employed by their genetic counselor that was helpful when receiving the news, which was found to align with the SPIKES protocol, a six-step process of delivering difficult news to patients. Additional techniques that participants identified as beneficial and satisfactory included the genetic counselor's use of empathy, non-directiveness, and continuity and coordination of care. Participants also provided recommendations for improvement, including a discussion of the mode of result disclosure during pretest counseling, an option to follow up with their genetic counselor, personalized resources, and a summary of the results call. The findings of this study demonstrate that a patient-centered approach is preferred by patients who receive difficult news by telephone in the prenatal setting. Patients' identification of beneficial communication techniques and suggestions for improvement can be implemented by any healthcare provider responsible for delivering difficult news to prenatal patients.
Collapse
Affiliation(s)
| | - Caitlyn May
- Certified Genetic Counselor, GeneScreen Counseling, Bernardsville, New Jersey, USA
| | - Karin Dent
- University of Utah Graduate Program in Genetic Counseling, Salt Lake City, Utah, USA.,Department of Pediatrics, Division of Medical Genetics, University of Utah, Utah, Salt Lake City, USA
| | - John C Carey
- Department of Pediatrics, Division of Medical Genetics, University of Utah, Utah, Salt Lake City, USA
| | - Janessa Mladucky
- Intermountain Healthcare, Precision Genomics, Salt Lake City, Utah, USA
| |
Collapse
|
9
|
Green S, Hartzfeld D, Terry AB, Fissell K, Friedman S, Paolino N, Principe K, Sandbach J, Trzupek K, Winheld S, Malinowski J. An evidence-based practice guideline of the National Society of Genetic Counselors for telehealth genetic counseling. J Genet Couns 2023; 32:4-17. [PMID: 36054686 DOI: 10.1002/jgc4.1627] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 07/22/2022] [Accepted: 07/27/2022] [Indexed: 11/12/2022]
Abstract
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.
Collapse
Affiliation(s)
- Sarah Green
- Institute for Digital Health and Innovation, High Risk Pregnancy Program, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Deborah Hartzfeld
- Department of Veterans Affairs, Genomic Medicine Service, Salt Lake City, Utah, USA
| | - Alissa Bovee Terry
- New York Mid-Atlantic-Caribbean Regional Genetics Network, Binghamton, New York, USA
| | | | - Sue Friedman
- Facing Our Risk of Cancer Empowered (FORCE), Tampa, Florida, USA
| | | | | | | | | | | | | |
Collapse
|
10
|
Williams HE, Aiyar L, Dinulos MB, Flannery D, McClure ML, Lloyd-Puryear MA, Sanghavi K, Trotter TL, Viskochil D. Considerations for policymakers for improving health care through telegenetics: A points to consider statement of the American College of Medical Genetics and Genomics (ACMG). Genet Med 2022; 24:2211-2219. [PMID: 36040445 DOI: 10.1016/j.gim.2022.07.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 07/21/2022] [Indexed: 11/28/2022] Open
Affiliation(s)
- Heather E Williams
- Department of Pathology and Cell Biology, Columbia University, New York, NY; School of Management, Yale University, New Haven, CT
| | - Lila Aiyar
- Genomics Section, Hawaii Department of Health, Honolulu, HI
| | - Mary Beth Dinulos
- Departments of Pediatrics and Pathology, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - David Flannery
- Center for Personalized Genetic Healthcare, Cleveland Clinic, Cleveland, OH
| | | | - Michele A Lloyd-Puryear
- Retired from Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Kunal Sanghavi
- The Jackson Laboratory for Genomic Medicine, The Jackson Laboratory, Farmington, CT
| | - Tracy L Trotter
- Department of Pediatrics, John Muir Health, San Francisco, CA
| | - David Viskochil
- Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, UT
| | -
- American College of Medical Genetics and Genomics, Bethesda, MD
| |
Collapse
|
11
|
Liang LW, Kalia I, Latif F, Waase MP, Shimada YJ, Sayer G, Reilly MP, Uriel N. The use of telemedicine in cardiogenetics clinical practice during the COVID-19 pandemic. Mol Genet Genomic Med 2022; 10:e1946. [PMID: 35388985 PMCID: PMC9184656 DOI: 10.1002/mgg3.1946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 03/25/2022] [Indexed: 11/11/2022] Open
Abstract
Background The COVID‐19 pandemic has necessitated the rapid and widespread adoption of novel mechanisms of service delivery, including the use of telemedicine. The aim of this study was to examine the impact of COVID‐19 on cardiogenetics practices. Methods We retrospectively analyzed the clinical characteristics of patients who were seen for cardiogenetics visits pre‐pandemic (1 April–23 December 2019) and during the pandemic (1 April–23 December 2020) at Columbia University Irving Medical Center. Results Six percent (n = 6) of visits in 2019 were remote telemedicine encounters, whereas 80% (n = 106) of visits in 2020 were telemedicine encounters. In 2019, only 18% (n = 19) of the patients seen for genetic counseling were family members of probands; this percentage increased to 34% in 2020 (n = 45; p = .01). In 2020, the geographic reach of genetic counseling also extended far beyond New York State, reaching a total of 11 states as well as one patient in Puerto Rico. Genetic testing results were similar in 2019 and 2020. Conclusion Despite the health‐care delivery barriers created by the COVID‐19 pandemic, the use of telemedicine allowed us to expand the reach of cardiovascular genetic counseling and testing.
Collapse
Affiliation(s)
- Lusha W. Liang
- Division of Cardiology, Department of MedicineColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Isha Kalia
- Division of Cardiology, Department of MedicineColumbia University Irving Medical CenterNew YorkNew YorkUSA
- Irving Institute for Clinical and Translational ResearchColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Farhana Latif
- Division of Cardiology, Department of MedicineColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Marc P. Waase
- Division of Cardiology, Department of MedicineColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Yuichi J. Shimada
- Division of Cardiology, Department of MedicineColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Gabriel Sayer
- Division of Cardiology, Department of MedicineColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Muredach P. Reilly
- Division of Cardiology, Department of MedicineColumbia University Irving Medical CenterNew YorkNew YorkUSA
- Irving Institute for Clinical and Translational ResearchColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Nir Uriel
- Division of Cardiology, Department of MedicineColumbia University Irving Medical CenterNew YorkNew YorkUSA
| |
Collapse
|
12
|
Pestoff R, Johansson P, Danielsson H, Neher M, Gunnarsson C. Rapid Implementation of Telegenetic Counseling in the COVID-19 and Swedish Healthcare Context: A Feasibility Study. FRONTIERS IN HEALTH SERVICES 2022; 2:848512. [PMID: 36925809 PMCID: PMC10012799 DOI: 10.3389/frhs.2022.848512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 05/27/2022] [Indexed: 11/13/2022]
Abstract
This study reports the process and preliminary findings of rapid implementation of telegenetic counseling in the context of Swedish healthcare and COVID-19 pandemic, from both a patient and a provider perspective. Fourty-nine patients and 6 healthcare professionals were included in this feasibility study of telegenetic counseling in a regional Department of Clinical Genetics in Sweden. Telegenetic counseling is here defined as providing genetic counseling to patients by video (n = 30) or telephone (n = 19) appointments. Four specific feasibility aspects were considered: acceptability, demand, implementation, and preliminary efficacy. Several measures were used including the Genetic Counseling Outcome Scale 24 (collected pre- and post-counseling); the Telehealth Usability Questionnaire; a short study specific evaluation and Visiba Care evaluations, all collected post-counseling. The measures were analyzed with descriptive statistics and the preliminary results show a high level of acceptance and demand, from both patients and providers. Results also indicate successful initial implementation in the regional Department of Clinical Genetics and preliminary efficacy, as shown by significant clinically important improvement in patients' empowerment levels.
Collapse
Affiliation(s)
- Rebecka Pestoff
- Centre for Rare Diseases in Southeast Region of Sweden, Linköping University, Linköping, Sweden.,Division of Community Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Department of Clinical Genetics, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Peter Johansson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Henrik Danielsson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Margit Neher
- Department of Rehabilitation, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Cecilia Gunnarsson
- Centre for Rare Diseases in Southeast Region of Sweden, Linköping University, Linköping, Sweden.,Division of Community Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Department of Clinical and Experimental Science, Linköping University, Linköping, Sweden
| |
Collapse
|
13
|
Breen KE, Tuman M, Bertelsen CE, Sheehan M, Wylie D, Fleischut MH, Offit K, Stadler ZK, Salo-Mullen EE, Hamilton JG. Factors Influencing Patient Preferences for Telehealth Cancer Genetic Counseling During the COVID-19 Pandemic. JCO Oncol Pract 2021; 18:e462-e471. [PMID: 34652959 DOI: 10.1200/op.21.00301] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
PURPOSE With onset of the COVID-19 pandemic, telehealth became the primary modality for health care appointments. This study examined patient experiences with and preferences for telehealth at a cancer genetic counseling clinic throughout the first 6 months of the pandemic (March-August 2020). METHODS An anonymous survey assessed patient demographics; usage and prior experience with technology; emotional responses, technical experiences, and satisfaction with the telehealth appointment (via the Genetic Counseling Satisfaction Scale and Visit-Specific Satisfaction Questionnaire); preference for future telehealth; and recommendation of telehealth to others. RESULTS Among 380 respondents, most were highly satisfied with the telehealth appointment (with 65.6% and 66.4% of participants completing the Genetic Counseling Satisfaction Scale and Visit-Specific Satisfaction Questionnaire, respectively). Multivariable analyses indicated several notable findings. Adjusting for relevant covariates, participants with less education felt significantly more concerned about telehealth than those with highest educational attainment. Participants age 40-69 years were generally more comfortable, relieved, and grateful that their appointment was scheduled as telehealth than were those older than 70 years. Women were marginally more relieved and grateful for telehealth appointments than men. As the pandemic progressed, significantly more participants were highly satisfied with their telehealth appointment and participants trended toward having greater preferences for future telehealth use. Most participants (78.6%) would recommend telehealth to others, although 50.8% preferred future in-person appointments. CONCLUSION As the pandemic progressed, patients expressed increasing preferences for and satisfaction with telehealth. Service delivery models that incorporate individual patient preferences should be developed with special consideration to factors such as age, sex, and education level.
Collapse
Affiliation(s)
- Kelsey E Breen
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Malwina Tuman
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Corinna E Bertelsen
- Department of Strategy and Innovation, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Margaret Sheehan
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - David Wylie
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Kenneth Offit
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Zsofia K Stadler
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Erin E Salo-Mullen
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jada G Hamilton
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.,Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
| |
Collapse
|
14
|
Higgs E, Dagan-Rosenfeld O, Snyder M. Adapting skills from genetic counseling to wearables technology research during the COVID-19 pandemic: Poised for the pivot. J Genet Couns 2021; 30:1269-1275. [PMID: 34580951 DOI: 10.1002/jgc4.1509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 09/01/2021] [Accepted: 09/03/2021] [Indexed: 11/10/2022]
Abstract
Genetic counselors have shown themselves to be adaptable in an evolving profession, with expansion into new sub-specialties, various non-clinical settings, and research roles. The COVID-19 pandemic caused a sudden and drastic shift in healthcare priorities. In an effort to contribute meaningfully to the COVID-19 crisis, and to adapt to a remote- and essential-only research environment, our workplace and thus our roles pivoted from genomics research to remote COVID-19 research using wearables technologies. With a deep understanding of genomic data, we were quickly able to apply similar concepts to wearables data including considering privacy implications, managing uncertain findings, and acknowledging the lack of ethnic diversity in many datasets. By sharing our own experience as an example, we hope individuals trained in genetic counseling may see opportunities for adaptation of their skills into expanding roles.
Collapse
Affiliation(s)
- Emily Higgs
- Department of Genetics, Stanford University, Stanford, CA, USA
| | | | - Michael Snyder
- Department of Genetics, Stanford University, Stanford, CA, USA
| |
Collapse
|
15
|
Tumulak MAJR, Pascua AV, Jover EJM, Guerbo RJ, Canoy GMR, Laurino MY. Genetic counseling in the time of COVID-19: The Philippine experience with telegenetics. J Genet Couns 2021; 30:1285-1291. [PMID: 34558759 PMCID: PMC8657528 DOI: 10.1002/jgc4.1518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 09/08/2021] [Accepted: 09/08/2021] [Indexed: 11/11/2022]
Abstract
The COVID-19 pandemic poses a significant challenge to healthcare professionals and health systems around the world, most notably the disruption of its service delivery. The typical work setting for most genetic counselors (GCs) is in a clinic or hospital. However, during the COVID-19 pandemic, to help prevent the further spread of the virus, clinics and hospitals have restricted non-urgent in-person delivery of healthcare services, including genetic counseling. Patients' access to genetic counseling services has thus been limited, which prompted GCs in the country to utilize an alternative way to provide counseling through telegenetics. With the expansion of genetic services in the country, including the full implementation of expanded newborn screening, there is an increasing demand for genetic counseling and a growing need for telegenetics.
Collapse
Affiliation(s)
- Ma-Am Joy R Tumulak
- Institute of Human Genetics, National Institutes of Health, University of the Philippines Manila, Manila, Philippines.,Department of Pediatrics, College of Medicine, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Angela V Pascua
- Institute of Human Genetics, National Institutes of Health, University of the Philippines Manila, Manila, Philippines
| | - Edbert Jasper M Jover
- Newborn Screening Center Mindanao, Southern Philippines Medical Center, Davao, Philippines
| | - Romer J Guerbo
- Newborn Screening Center Mindanao, Southern Philippines Medical Center, Davao, Philippines
| | - Graciel Mae R Canoy
- Newborn Screening Center Mindanao, Southern Philippines Medical Center, Davao, Philippines
| | - Mercy Y Laurino
- Department of Pediatrics, College of Medicine, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| |
Collapse
|
16
|
Borle K, Dey A, Carrion P, Austin J, Elliott AM. Genetic counseling research and COVID-19: A lesson in resiliency. J Genet Couns 2021; 30:1276-1284. [PMID: 34510629 PMCID: PMC8657337 DOI: 10.1002/jgc4.1502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 08/16/2021] [Accepted: 08/22/2021] [Indexed: 11/29/2022]
Abstract
GenCOUNSEL is the largest genetic counseling research grant awarded to date and brings together experts in genetic counseling, genomics, law and policy, health services implementation, and health economics research. It is the first project of its kind to examine the genetic counseling issues associated with the clinical implementation of genome‐wide sequencing (exome and genome sequencing). GenCOUNSEL is a Canadian‐based, multi‐method research study that takes place over a variety of sites, including non‐clinical, clinical, and laboratory research sites and includes the training of undergraduate and graduate students. The COVID‐19 pandemic will likely have a lasting impact on genetic counseling service delivery, research, and training. Almost every aspect of the GenCOUNSEL research project has been impacted by the COVID‐19 pandemic. Here we describe how our research recruitment strategies, methods, resource allocation, and training capacity have been affected. We discuss ways that we have adapted to the pandemic including revision of our research methods and work to understand the barriers in order to optimize opportunities. We finish with take‐home messages to fellow researchers highlighting the importance of resiliency in genetic counseling research.
Collapse
Affiliation(s)
- Kennedy Borle
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Alivia Dey
- Provincial Health Services Authority, Vancouver, BC, Canada
| | - Prescilla Carrion
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | -
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Jehannine Austin
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | - Alison M Elliott
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada.,BC Children's Hospital Research Institute, Vancouver, BC, Canada.,Women's Health Research Institute, Vancouver, BC, Canada
| |
Collapse
|
17
|
Uhlmann WR, McKeon AJ, Wang C. Genetic counseling, virtual visits, and equity in the era of COVID-19 and beyond. J Genet Couns 2021; 30:1038-1045. [PMID: 34291525 PMCID: PMC8426877 DOI: 10.1002/jgc4.1469] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 06/18/2021] [Accepted: 06/20/2021] [Indexed: 11/30/2022]
Abstract
Overnight, as a result of the COVID‐19 pandemic, telehealth rapidly transitioned from limited application to widespread implementation. The field of genetic counseling was well positioned to make this transition to virtual care since there is generally less of a need for patients to be seen in‐person for physical exams or urgent care. Going forward, virtual visits will presumably become a mainstay in the provision of genetic services and it is anticipated that clinics will adopt “hybrid” models with both in‐person and virtual visit options. This commentary highlights the successes and challenges in the rapid implementation of virtual visits, focusing on who has benefited versus who has been challenged or left behind. We also discuss genetic testing considerations, including the additional steps required for patients and clinicians when testing is ordered outside of the clinical setting, which can result in delays or a lack of testing altogether. Future research considerations are presented to address the needs among the most vulnerable and help ensure equitable access and benefit.
Collapse
Affiliation(s)
- Wendy R Uhlmann
- Division of Genetic Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.,Department of Human Genetics, University of Michigan, Ann Arbor, Michigan, USA.,Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Andrew J McKeon
- Department of Human Genetics, University of Michigan, Ann Arbor, Michigan, USA
| | - Catharine Wang
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts, USA
| |
Collapse
|
18
|
Dratch L, Paul RA, Baldwin A, Brzozowski M, Gonzalez-Alegre P, Tropea TF, Raper A, Bardakjian T. Transitioning to telegenetics in the COVID-19 era: Patient satisfaction with remote genetic counseling in adult neurology. J Genet Couns 2021; 30:974-983. [PMID: 34265143 PMCID: PMC8427091 DOI: 10.1002/jgc4.1470] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 06/17/2021] [Accepted: 06/20/2021] [Indexed: 01/13/2023]
Abstract
The COVID-19 pandemic rapidly changed genetic counseling services across the United States. At the University of Pennsylvania (UPenn), a large academic hospital in an urban setting, nearly all genetic counseling (GC) visits for adult-onset disorders within the Department of Neurology were conducted via secure videoconferencing (telegenetics) or telephone between March and December 2020. Although telemedicine services have been steadily emerging, many clinical programs, including the neurogenetics program at UPenn, had not built infrastructure or widely utilized these services prior to the pandemic. Thus, little is known about patient attitudes toward receiving clinical GC services remotely. From May 18 to October 18, 2020, all individuals seen remotely for GC in adult neurology via telephone or telegenetics were surveyed about their satisfaction with telehealth GC (N = 142), with a response rate of 42% (N = 60/142). Telephone and telegenetics services were referred to as 'telehealth' in the surveys to capture patient perspectives on all remote GC services, though the majority (N = 49/60) of these visits were completed via telegenetics. Surveys included the modified telehealth usability questionnaire (MTUQ), genetic counseling satisfaction scale (GCSS), and novel questions about future telehealth use. Preliminary results suggest that patients were satisfied with receiving remote GC services in adult neurology, with most participants strongly agreeing to all items about satisfaction with telehealth. Just 2% of participants preferred only in-person visits in the future, but every participant was willing to consider using telehealth for future visits if their genetic counselor felt it was appropriate. Most participants preferred a hybrid model (73%), and some (25%) preferred only telehealth for future visits. Additionally, we found no differences in satisfaction with remote services based on visit type (initial vs. results disclosure) nor age. We conclude that remote GC is an acceptable method for the provision of services in adult neurology that is well-received by patients.
Collapse
Affiliation(s)
- Laynie Dratch
- Department of Neurology, Neurogenetics Translational Center of Excellence, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rachel A Paul
- Department of Neurology, Neurogenetics Translational Center of Excellence, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Aaron Baldwin
- Department of Neurology, Neurogenetics Translational Center of Excellence, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Morgan Brzozowski
- Department of Neurology, Neurogenetics Translational Center of Excellence, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Pedro Gonzalez-Alegre
- Department of Neurology, Neurogenetics Translational Center of Excellence, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Thomas F Tropea
- Department of Neurology, Neurogenetics Translational Center of Excellence, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Anna Raper
- Department of Neurology, Neurogenetics Translational Center of Excellence, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Tanya Bardakjian
- Department of Neurology, Neurogenetics Translational Center of Excellence, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|
19
|
Allain DC, Randall Armel S, Carmany EP, Creswick H, McBrien SB, Reed EK, Williams JL. The Accreditation Council for Genetic Counseling's response to COVID-19 impact on genetic counseling programs. J Genet Couns 2021; 30:1046-1056. [PMID: 34224607 PMCID: PMC8426665 DOI: 10.1002/jgc4.1456] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 05/06/2021] [Accepted: 05/22/2021] [Indexed: 11/22/2022]
Affiliation(s)
- Dawn C Allain
- Division of Human Genetics, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Susan Randall Armel
- Department of Medicine, Familial Cancer Clinic, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Erin P Carmany
- Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, MI, USA
| | | | - Sarah B McBrien
- College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NB, USA
| | | | | |
Collapse
|