1
|
Chu ATW, Chung CCY, Hue SPY, Chung BHY. The growing needs of genetic counselling-Feasibility in utilization of tele-genetic counselling in Asia and Hong Kong. Front Genet 2023; 14:1239817. [PMID: 37600657 PMCID: PMC10435751 DOI: 10.3389/fgene.2023.1239817] [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: 06/14/2023] [Accepted: 07/20/2023] [Indexed: 08/22/2023] Open
Abstract
The need for the expansion of genomic services has been at a record time high in the past decade. As technological advancement continues to strengthen the entire genetic and genomic pipeline and clinical operational workflow, the major challenge remains to be the speed of workforce development to meet service growth. In particular, the international expansion of genetic counselling (GC) services has been a topic of interest for the past few years. GC is an emerging profession in most of Asia, and in many countries the profession of GC often refers to physicians or front-line health workers with expertise in genetics to provide GC services rather than being a specific independent profession. As genetic and genomic services, especially pre-test and post-test GC, expand globally, the need to tackle the longstanding obstacles of GC personnel shortage and funding issues must not be overlooked. There is an urgent need internationally, and especially in Asia, where GC profession is comparatively less well-established, to seek alternative approaches to meet service demand. The present review examines the global development and feasibility of tele-genetics and tele-genetic counselling (TGC), and serves as the foundation to explore a possible roadmap in Hong Kong via the Hong Kong Genome Project.
Collapse
Affiliation(s)
| | | | | | - Brian Hon Yin Chung
- Hong Kong Genome Institute, Hong Kong, Hong Kong SAR, China
- Department of Paediatrics and Adolescent Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| |
Collapse
|
2
|
Danylchuk NR, Cook L, Shane-Carson KP, Cacioppo CN, Hardy MW, Nusbaum R, Steelman SC, Malinowski J. Telehealth for genetic counseling: A systematic evidence review. J Genet Couns 2021; 30:1361-1378. [PMID: 34355839 DOI: 10.1002/jgc4.1481] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 06/28/2021] [Accepted: 06/29/2021] [Indexed: 12/25/2022]
Abstract
Telehealth options, such as telephone counseling or videoconferencing, for service delivery in genetic counseling are becoming more widely accepted. However, until now, there has not been a systematic review of the literature focused specifically on genetic counseling outcomes for telehealth. We performed a systematic evidence review to compare telehealth genetic counseling (THGC), including videoconferencing and telephone counseling, across specialties to in-person genetic counseling (IPGC) for a range of outcomes specific to patient and provider experiences and access to care. Several biomedical databases were queried up to January 11, 2021, to identify original research evaluating THGC. Through this search, 42 articles met the inclusion criteria including 13 randomized controlled trials and 29 non-randomized observational studies encompassing 13,901 patients. Most included studies focused only on cancer genetic counseling; however, adult, pediatric, and prenatal specialties were also represented. The majority of studies evaluated patient and/or access to care outcomes. Though most studies reported high patient satisfaction with THGC, as well as comparable rates of trust and rapport, confidence in privacy, health behavior changes, and psychosocial outcomes, few represented diverse populations. Data of provider experiences were limited and varied with more disadvantages noted compared with patient experiences, particularly in studies involving telephone genetic counseling. Studies consistently reported a decrease in the patients' costs and time required for travel when patients are seen via THGC compared to IPGC with a similar reduction in costs to the health system. Overall, results from our evidence synthesis suggest THGC is non-inferior or comparable to IPGC across many domains, even considering that many of the studies included in this review were conducted with telehealth systems, notably videoconferencing, that were less robust and reliable than what is available today. There are notable limitations within this body of literature, leading to potential uncertainty in the generalizability of our analysis. We outline several recommendations for future studies.
Collapse
Affiliation(s)
- Noelle R Danylchuk
- Department of Genetic Counseling, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Lola Cook
- Department of Medical & Molecular Genetics, Indiana U School of Medicine, Indianapolis, Indiana, USA
| | - Kate P Shane-Carson
- Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Cara N Cacioppo
- Penn Telegenetics Program, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Rachel Nusbaum
- University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Susan C Steelman
- University of Arkansas for Medical Sciences Library, Little Rock, Arkansas, USA
| | | |
Collapse
|
3
|
Bradbury AR, Patrick-Miller LJ, Egleston BL, Hall MJ, Domchek SM, Daly MB, Ganschow P, Grana G, Olopade OI, Fetzer D, Brandt A, Chambers R, Clark DF, Forman A, Gaber R, Gulden C, Horte J, Long JM, Lucas T, Madaan S, Mattie K, McKenna D, Montgomery S, Nielsen S, Powers J, Rainey K, Rybak C, Savage M, Seelaus C, Stoll J, Stopfer JE, Yao XS. Randomized Noninferiority Trial of Telephone vs In-Person Disclosure of Germline Cancer Genetic Test Results. J Natl Cancer Inst 2019; 110:985-993. [PMID: 29490071 DOI: 10.1093/jnci/djy015] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 01/18/2018] [Indexed: 12/16/2022] Open
Abstract
Background Germline genetic testing is standard practice in oncology. Outcomes of telephone disclosure of a wide range of cancer genetic test results, including multigene panel testing (MGPT) are unknown. Methods Patients undergoing cancer genetic testing were recruited to a multicenter, randomized, noninferiority trial (NCT01736345) comparing telephone disclosure (TD) of genetic test results with usual care, in-person disclosure (IPD) after tiered-binned in-person pretest counseling. Primary noninferiority outcomes included change in knowledge, state anxiety, and general anxiety. Secondary outcomes included cancer-specific distress, depression, uncertainty, satisfaction, and screening and risk-reducing surgery intentions. To declare noninferiority, we calculated the 98.3% one-sided confidence interval of the standardized effect; t tests were used for secondary subgroup analyses. Only noninferiority tests were one-sided, others were two-sided. Results A total of 1178 patients enrolled in the study. Two hundred eight (17.7%) participants declined random assignment due to a preference for in-person disclosure; 473 participants were randomly assigned to TD and 497 to IPD; 291 (30.0%) had MGPT. TD was noninferior to IPD for general and state anxiety and all secondary outcomes immediately postdisclosure. TD did not meet the noninferiority threshold for knowledge in the primary analysis, but it did meet the threshold in the multiple imputation analysis. In secondary analyses, there were no statistically significant differences between arms in screening and risk-reducing surgery intentions, and no statistically significant differences in outcomes by arm among those who had MGPT. In subgroup analyses, patients with a positive result had statistically significantly greater decreases in general anxiety with telephone disclosure (TD -0.37 vs IPD +0.87, P = .02). Conclusions Even in the era of multigene panel testing, these data suggest that telephone disclosure of cancer genetic test results is as an alternative to in-person disclosure for interested patients after in-person pretest counseling with a genetic counselor.
Collapse
Affiliation(s)
- Angela R Bradbury
- Division of Hematology-Oncology, Department of Medicine, Department of Medical Ethics and Health Policy, and Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Linda J Patrick-Miller
- Division of Hematology-Oncology and Section of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, and Center for Clinical Cancer Genetics and Global Health, The University of Chicago, Chicago, IL
| | - Brian L Egleston
- Biostatistics and Bioinformatics Facility and Department of Medical Genetics, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA
| | - Michael J Hall
- Biostatistics and Bioinformatics Facility and Department of Medical Genetics, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA
| | - Susan M Domchek
- Division of Hematology-Oncology, Department of Medicine, Department of Medical Ethics and Health Policy, and Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Mary B Daly
- Biostatistics and Bioinformatics Facility and Department of Medical Genetics, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA
| | - Pamela Ganschow
- Department of Internal Medicine, The John H. Stroger Jr. Hospital of Cook County, Chicago, IL
| | - Generosa Grana
- Division of Hematology-Oncology, MD Anderson Cancer Center at Cooper, Camden, NJ
| | - Olufunmilayo I Olopade
- Division of Hematology-Oncology and Section of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, and Center for Clinical Cancer Genetics and Global Health, The University of Chicago, Chicago, IL
| | - Dominique Fetzer
- Division of Hematology-Oncology, Department of Medicine, Department of Medical Ethics and Health Policy, and Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Amanda Brandt
- Division of Hematology-Oncology, Department of Medicine, Department of Medical Ethics and Health Policy, and Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Rachelle Chambers
- Division of Hematology-Oncology and Section of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, and Center for Clinical Cancer Genetics and Global Health, The University of Chicago, Chicago, IL
| | - Dana F Clark
- Division of Hematology-Oncology, MD Anderson Cancer Center at Cooper, Camden, NJ
| | - Andrea Forman
- Biostatistics and Bioinformatics Facility and Department of Medical Genetics, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA
| | - Rikki Gaber
- Department of Internal Medicine, The John H. Stroger Jr. Hospital of Cook County, Chicago, IL
| | - Cassandra Gulden
- Division of Hematology-Oncology and Section of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, and Center for Clinical Cancer Genetics and Global Health, The University of Chicago, Chicago, IL
| | - Janice Horte
- Division of Hematology-Oncology, MD Anderson Cancer Center at Cooper, Camden, NJ
| | - Jessica M Long
- Division of Hematology-Oncology, Department of Medicine, Department of Medical Ethics and Health Policy, and Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Terra Lucas
- Department of Internal Medicine, The John H. Stroger Jr. Hospital of Cook County, Chicago, IL
| | - Shreshtha Madaan
- Division of Hematology-Oncology and Section of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, and Center for Clinical Cancer Genetics and Global Health, The University of Chicago, Chicago, IL
| | - Kristin Mattie
- Division of Hematology-Oncology, MD Anderson Cancer Center at Cooper, Camden, NJ
| | - Danielle McKenna
- Division of Hematology-Oncology, Department of Medicine, Department of Medical Ethics and Health Policy, and Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Susan Montgomery
- Biostatistics and Bioinformatics Facility and Department of Medical Genetics, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA
| | - Sarah Nielsen
- Division of Hematology-Oncology and Section of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, and Center for Clinical Cancer Genetics and Global Health, The University of Chicago, Chicago, IL
| | - Jacquelyn Powers
- Division of Hematology-Oncology, Department of Medicine, Department of Medical Ethics and Health Policy, and Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Kim Rainey
- Biostatistics and Bioinformatics Facility and Department of Medical Genetics, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA
| | - Christina Rybak
- Biostatistics and Bioinformatics Facility and Department of Medical Genetics, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA
| | - Michelle Savage
- Biostatistics and Bioinformatics Facility and Department of Medical Genetics, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA
| | - Christina Seelaus
- Department of Internal Medicine, The John H. Stroger Jr. Hospital of Cook County, Chicago, IL
| | - Jessica Stoll
- Division of Hematology-Oncology and Section of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, and Center for Clinical Cancer Genetics and Global Health, The University of Chicago, Chicago, IL
| | - Jill E Stopfer
- Division of Hematology-Oncology, Department of Medicine, Department of Medical Ethics and Health Policy, and Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Xinxin Shirley Yao
- Division of Hematology-Oncology, MD Anderson Cancer Center at Cooper, Camden, NJ
| |
Collapse
|
5
|
Trepanier AM, Allain DC. Models of service delivery for cancer genetic risk assessment and counseling. J Genet Couns 2013; 23:239-53. [PMID: 24158360 DOI: 10.1007/s10897-013-9655-6] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 08/30/2013] [Indexed: 10/26/2022]
Abstract
Increasing awareness of and the potentially concomitant increasing demand for cancer genetic services is driving the need to explore more efficient models of service delivery. The aims of this study were to determine which service delivery models are most commonly used by genetic counselors, assess how often they are used, compare the efficiency of each model as well as impact on access to services, and investigate the perceived benefits and barriers of each. Full members of the NSGC Familial Cancer Special Interest Group who subscribe to its listserv were invited to participate in a web-based survey. Eligible respondents were asked which of ten defined service delivery models they use and specific questions related to aspects of model use. One-hundred ninety-two of the approximately 450 members of the listserv responded (42.7%); 177 (92.2%) had provided clinical service in the last year and were eligible to complete all sections of the survey. The four direct care models most commonly used were the (traditional) face-to-face pre- and post-test model (92.2%), the face-to-face pretest without face-to-face post-test model (86.5%), the post-test counseling only for complex results model (36.2%), and the post test counseling for all results model (18.3%). Those using the face-to-face pretest only, post-test all, and post-test complex models reported seeing more new patients than when they used the traditional model and these differences were statistically significantly. There were no significant differences in appointment wait times or distances traveled by patients when comparing use of the traditional model to the other three models. Respondents recognize that a benefit of using alternative service delivery models is increased access to services; however, some are concerned that this may affect quality of care.
Collapse
Affiliation(s)
- Angela M Trepanier
- Center for Molecular Medicine and Genetics, Wayne State University, 540 E. Canfield Street, 2375 Scott Hall, Detroit, MI, 48201, USA,
| | | |
Collapse
|
8
|
Chou AF, Norris AI, Williamson L, Garcia K, Baysinger J, Mulvihill JJ. Quality assurance in medical and public health genetics services: a systematic review. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2009; 151C:214-34. [PMID: 19621459 DOI: 10.1002/ajmg.c.30219] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
As genetic services grow in scope, issues of quality assessment in genetic services are emerging. These efforts are well developed for molecular and cytogenetic testing and laboratories, and newborn screening programs, but assessing quality in clinical services has lagged, perhaps owing to the small work force and the recent evolution from a few large training programs to multiple training sites. We surveyed the English language, peer-reviewed literature to summarize the knowledge-base of quality assessment of genetics services, organized into the tripartite categories of the Donabedian model of "structure," "process," and "outcome." MEDLINE searches from 1990 to July 2008, yielded 2,143 articles that addressed both "medical/genetic screening and counseling" and "quality indicators, control, and assurance." Of the 2,143 titles, 131 articles were extracted for in-depth analysis, and 55 were included in this review. Twenty-nine articles focused on structure, 19 on process, and seven on outcomes. Our review underscored the urgent need for a coherent model that will provide health care organizations with tools to assess, report, monitor, and improve quality. The structure, process, and outcomes domains that make up the quality framework provide a comprehensive lens through which to examine quality in medical genetics.
Collapse
Affiliation(s)
- Ann F Chou
- Department of Health Administration and Policy, College of Public Health, University of Oklahoma Health Sciences Center, 801 NE 13th St., CHB 355, Oklahoma City, OK 73104, USA.
| | | | | | | | | | | |
Collapse
|