Cost-effectiveness evaluation of pre-counseling telephone interviews before face-to-face genetic counseling in cancer genetics

Abstract

One of the main challenges in cancer genetics is responding to the exponential demand for genetic counseling, especially in patients with breast and/or ovarian cancer. To address this demand, we have set up a new procedure, based on pre-genetic counseling telephone interviews (PTI) followed by routing of patients: D1, a PTI is scheduled within 14 days; D7-D14, genetic counselors perform a 20 min PTI in order to establish a pre-genetic counseling file, by collecting personal and family medical history via a structured questionnaire and; D10-17, routing: pre-genetic counseling appointment files are analyzed by a cancer geneticist with 3 possible conclusions: (a) priority face-to-face genetic counseling (FTFGC) appointment with a cancer geneticist, if the genetic test results have an immediate therapeutic impact; (b) non-priority FTFGC with a genetic counselor, or (c) no FTFGC required or substitution by a more appropriate index case. In the context of breast and/or ovarian cancer, 1012 patients received PTIs, 39.1% of which did not lead to FTFGC. The mean delay for non-priority FTFGC was maintained at 18 weeks and priority FTFGC appointments were guaranteed within 8 weeks. The required resources for 1012 patients was estimated at 0.12 FTE secretaries, 0.62 FTE genetic counselors and 0.08 FTE cancer geneticists and the procedure was shown to be cost-effective. This new procedure allows the suppression of up to 1/3 of appointments, guarantees priority for appointments with therapeutic impact and optimizes the interaction and breakdown of tasks between genetic counselors and cancer geneticists.

How and when to refer patients for oncogenetic counseling in the era of PARP inhibitors

“…discuss how the indications for genetic testing and the turnaround time for consultations can be improved. 15,37–39 As reported by George and colleagues, new genetic testing pathways have been proposed. 15 In this study, genetic counseling is performed by a trained oncologist prior to germline testing.…”

“…In a French study, a first telephone interview was conducted by genetic counselors and/or physicians to identify the familial risk requiring a complete genetic work-up. 37 The study showed that pre-counseling telephone interviews were cost-effective as they did not lead to consultations in 39% of cases due to the absence of a significant medical history or by designating a more appropriate index case. In a Swedish study, telephone interviews were conducted by a well-trained nurse and a physician to replace the initial part of face-to-face counseling sessions.…”

“…39 Another emerging approach is telephone interviews or telemedicine before face-to-face genetic counseling and testing. 37,40,41 Patients can be better selected for oncogenetic consultations and the initial information can be given to patients by trained caregivers during telephone interviews or face-to-face consultations. In a French study, a first telephone interview was conducted by genetic counselors and/or physicians to identify the familial risk requiring a complete genetic work-up.…”