Pretest Genetic Education Video Versus Genetic Counseling for Men Considering Prostate Cancer Germline Testing: A Patient-Choice Study to Address Urgent Practice Needs

Abstract

PURPOSE Germline testing (GT) for prostate cancer (PCA) is now central to treatment and hereditary cancer assessment. With rising demand for and shortage of genetic counseling (GC), tools to deliver pretest informed consent across practice settings are needed to improve access to GT and precision care. Here, we report on Evaluation and Management for Prostate Oncology, Wellness, and Risk (EMPOWER), a patient-choice study for pretest video-based genetic education (VBGE) versus GC to inform urgent practice needs. PATIENTS AND METHODS Men with PCA or at risk for PCA (family history of PCA) were eligible and could choose pretest VBGE or GC. Outcomes included decisional conflict for GT, change in genetics knowledge, satisfaction, and intention to share results with family and/or providers. Descriptive statistics summarized results with counts and percentages for categorical variables and mean ± standard deviation for continuous variables. Data were compared with Fisher's exact, chi-squared, or Wilcoxon two-sample tests. Mean change in genetics knowledge was compared with t tests. The significance level was set a priori at .05. RESULTS Data on the first 127 participants were analyzed. Characteristics were White (85.8%), bachelor's degree (66.9%), and PCA diagnosis (90.6%). The majority chose VBGE (71%) versus GC (29%; P < .001). No differences were observed in decisional conflict for GT or satisfaction. Cancer genetics knowledge improved in both groups without significant difference (+0.9 VBGE, +1.8 GC, P = .056). Men who chose VBGE had higher intention to share GT results (96.4% VBGE v 86.4% GC, P = .02). Both groups had high rates of GT uptake (VBGE 94.4%, GC 92%). CONCLUSION A substantial proportion of men opted for pretest VBGE, with comparable patient-reported outcomes and uptake of GT. The results support the use of pretest video to address the critical GC shortage in the precision era.

Germline testing and genetic counselling in prostate cancer

“…Multiple elements need to be discussed and understood by patients to make an informed decision for testing 2 , 7 , 9 , 10 . To facilitate pre-test information delivery, videos are being studied in which patients view a genetics education video to understand the genetic testing process and considerations before pursuing genetic testing 72 . Patient-reported outcomes in a male population undergoing prostate cancer germline testing from one study ( n = 127) revealed that most men (71%) chose a pre-test video compared with genetic counselling (29%) ( P < 0.001), with no negative effect on patient satisfaction, decisional conflict for genetic testing, cancer genetics knowledge or uptake of genetic testing 72 .…”

Patient Understanding of Tumor Genomic Testing: A Quality Improvement Effort

“…17 More recent work specifically in men considering prostate cancer germline testing, with 71% of men opting for pretest video-based genetic education (relative to genetic counseling), with comparable patient-reported outcomes and uptake of germline testing. 18 Pretest video education is being implemented in some settings, for example, Memorial Sloan Kettering-Integrated Mutation Profiling of Actionable Cancer Targets tumor and normal testing program, in which patients who desire germline DNA annotation receive pretest genetic counseling via an IRB-approved video. 19 Bradbury et al 20 completed the Eastern Cooperative Oncology Group-American College of Radiology Imaging Network National Cancer Institute Community Oncology Research Program EAQ152 study, a randomized trial of web-based genetic education versus usual care in patients with advanced cancer undergoing tumor genetic testing, and found that a web-based video intervention increased patient understanding but did not significantly reduce anxiety, depression, or cancer-specific distress.…”

“…17 More recent work specifically in men considering prostate cancer germline testing, with 71% of men opting for pretest video-based genetic education (relative to genetic counseling), with comparable patient-reported outcomes and uptake of germline testing. 18 Pretest video education is being implemented in some settings, for example, Memorial Sloan Kettering-Integrated Mutation Profiling of Actionable Cancer Targets tumor and normal testing program, in which patients who desire germline DNA annotation receive pretest genetic counseling via an IRB-approved video. 19 Bradbury et al 20 Although this PDSA effort seeks to address gaps in patient education, there remain other important systematic challenges around widespread implementation of TGT in clinical practice.…”

Clinical Impact of a Rapid Genetic Testing Model for Advanced Prostate Cancer Patients

“…Interestingly, patients with lower educational attainment were more satisfied with the pretest education, suggesting an even more impactful role for this video and brochure in serving populations with lower education and/or health literacy. With the recent increase in use of telemedicine 31 and initial studies suggesting that patients undergoing genetic testing may even prefer video-based education over traditional genetic counseling, 32 this prostate-specific educational video (available in Supplementary Appendix A, https://www.jurology.com) may serve as a valuable clinical tool. Additionally, the majority of participants in this study did not request an in-person genetics consultation after receipt of results.…”