Genetic counseling, virtual visits, and equity in the era of COVID‐19 and beyond

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.

Germline Variant Spectrum Among African American Men Undergoing Prostate Cancer Germline Testing: Need for Equity in Genetic Testing

“…25 This testing involves evaluation of a blood specimen and therefore requires infrastructure support to coordinate blood collection, which may be challenging in the COVID-19 pandemic and postpandemic era since much of genetic evaluation has shifted to virtual visits with remote saliva sample collection for GT. 26,27 Mobile phlebotomy and other types of care processes will likely need to be considered more diligently in diverse populations when addressing implementation of RNA testing. 27 In addition, expanded panel testing may be needed to systematically test a larger set of genes among AA men to identify and characterize variants in genes of high or moderate penetrance given that multiple studies have now shown that AA men have a narrow spectrum of germline variants from standard multigene panels.…”

“…26,27 Mobile phlebotomy and other types of care processes will likely need to be considered more diligently in diverse populations when addressing implementation of RNA testing. 27 In addition, expanded panel testing may be needed to systematically test a larger set of genes among AA men to identify and characterize variants in genes of high or moderate penetrance given that multiple studies have now shown that AA men have a narrow spectrum of germline variants from standard multigene panels. [14][15][16][17] Genetics research findings from genomewide association studies and large population studies also provide insights into the PCA germline spectrum regarding common variants and need further study to determine the clinical role in AA men.…”

Demographic Barriers for Genetic Testing in High-Risk Breast Cancer Patients in the Northern Michigan Area

“…Lower socioeconomic status contributes to an inability to afford the travel to the available genetic counseling location and/or lack of resources to follow through with virtual counseling. Virtual genetic counseling services have been available for years; however, with the COVID-19 pandemic, the benefits of virtual counseling have become very apparent [ 19 ]. The importance of recognizing patients who cannot carry this financial burden is crucial because they are at risk of being lost to follow-up.…”

Barriers, interventions, and recommendations: Improving the genetic testing landscape

“…Importantly, an aspect of physician support that will be critical as we move towards a population-based screening model is effective integration of genetic information in the EHR ( 39 – 43 ). Additionally, telemedicine and telephone delivery strategies (expanded since the onset of the COVID-19 pandemic) offer the opportunity to expand accessibility of genetic counseling services ( 44 , 45 ), although reported success of these types of interventions varies ( 2 ) and concerns about equity in access remain ( 46 ).…”