Telegenetics – genetic counseling via live videoconferencing – can improve access to cancer genetic counseling (CGC) in underserved areas, but studies on cancer telegenetics have not applied randomized methodology or assessed cost. We report cost, patient satisfaction and CGC attendance from a randomized trial comparing telegenetics with in-person CGC among individuals referred to CGC in four rural oncology clinics. Participants (n=162) were randomized to receive CGC at their local oncology clinic in-person or via telegenetics. Cost analyses included telegenetics system; mileage; and personnel costs for genetic counselor, IT specialist, and clinic personnel. CGC attendance was tracked via study database. Patient satisfaction was assessed one week post-CGC via telephone survey using validated scales. Total costs were $106 per telegenetics patient and $244 per in-person patient. Patient satisfaction did not differ by group on either satisfaction scale. In-person patients were significantly more likely to attend CGC than telegenetics patients (89% vs. 79%, p=0.03), with bivariate analyses showing an association between lesser computer comfort and lower attendance rate (Chi-square=5.49, p=0.02). Our randomized trial of telegenetics vs. in-person counseling found that telegenetics cost less than in-person counseling, with high satisfaction among those who attended. This study provides support for future randomized trials comparing multiple service delivery models on longer-term psychosocial and behavioral outcomes.

Level III-case series.

Aims To test the efficacy of a brief intervention to reduce alcohol or drug use and to promote use of addiction services among patients seeking mental health treatment. Design and setting A multi‐centre, longitudinal, two‐group randomized controlled trial with randomization within each of two mental health treatment systems located in Ventura County and Los Angeles County in California, USA. Participants A total of 718 patients (49.2% female) aged 18 and older with a mental health diagnosis and either a heavy drinking day or any use of cannabis or stimulants in the past 90 days. Intervention and comparator A motivation‐based brief intervention with personalized feedback (screening, brief intervention and referral to treatment (SBIRT) condition) (n = 354) or a health education session (control condition) (n = 364). Measurements Primary outcomes included frequency of heavy drinking days, days of cannabis use and days of stimulant use at the primary end‐point 3 months post‐baseline. Secondary outcomes included frequency and abstinence from substance use out to a 12‐month follow‐up and the use of addiction treatment services. Findings Participants in the SBIRT condition had fewer heavy drinking days [odds ratio (OR) = 0.53; 95% credible interval (CrI) = 0.48–0.6] and fewer days of stimulant use (OR = 0.58; 95% CrI = 0.50–0.66) at the 3‐month follow‐up compared with participants in the health education condition. Participants in the SBIRT condition did not comparatively reduce days of cannabis use at the 3‐month follow‐up (OR = 0.93; 95% CrI = 0.85–1.01). Secondary outcomes indicated sustained effects of SBIRT on reducing the frequency of heavy drinking days and days of stimulant use. No effects were observed on abstinence rates or use of addiction treatment services. Conclusions Screening and brief intervention for unhealthy alcohol and drug use in mental health treatment settings were effective at reducing the frequency of heavy drinking and stimulant use.

Objective One-repetition maximum (1-RM) bench press strength is considered the gold standard to quantify upper-body muscular strength. Isometric handgrip strength is frequently used as a surrogate for 1-RM bench press strength among breast cancer (BrCa) survivors. The relationship between 1-RM bench press strength and isometric handgrip strength, however, has not been characterized among BrCa survivors. Design Cross-sectional study. Setting Laboratory. Participants Community-dwelling BrCa survivors. Interventions Not applicable. Main Outcome Measure 1-RM bench press strength was measured with a barbell and exercise bench. Isometric handgrip strength was measured using an isometric dynamometer with three maximal contractions of left and right hands. All measures were conducted by staff with training in clinical exercise testing. Results Among 295 BrCa survivors, 1-RM bench press strength was 18.2±6.1 kg (range: 2.2-43.0) and isometric handgrip strength was 23.5±5.8 kg (range: 9.0-43.0). The strongest correlate of 1-RM bench press strength was the average isometric handgrip strength of both hands (r=0.399; P<0.0001). Mean-difference analysis suggested that the average isometric handgrip strength of both hands overestimated 1-RM bench press strength by 4.7 kg (95% limits of agreement: −8.2 to 17.6). In a multivariable linear regression model, the average isometric handgrip strength of both hands (β=0.31; P<0.0001) and age (β=−0.20; P<0.0001) were positively correlated with 1-RM bench press strength (R2=0.23). Conclusions Isometric handgrip strength is a poor surrogate for 1-RM bench press strength among BrCa survivors. 1-RM bench press and isometric handgrip strength quantify distinct components of muscular strength.

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.