Utilizing Remote Real-Time Videoconferencing to Expand Access to Cancer Genetic Services in Community Practices: A Multicenter Feasibility Study

Abstract

BackgroundVideoconferencing has been used to expand medical services to low-access populations and could increase access to genetic services at community sites where in-person visits with genetic providers are not available.ObjectiveTo evaluate the feasibility of, patient feedback of, and cognitive and affective responses to remote two-way videoconferencing (RVC) telegenetic services at multiple sociodemographically diverse community practices without access to genetic providers.MethodsPatients at 3 community sites in 2 US states outside the host center completed RVC pretest (visit 1, V1) and post-test (visit 2, V2) genetic counseling for cancer susceptibility. Surveys evaluated patient experiences, knowledge, satisfaction with telegenetic and cancer genetics services, anxiety, depression, and cancer worry.ResultsA total of 82 out of 100 (82.0%) approached patients consented to RVC services. A total of 61 out of 82 patients (74%) completed pretest counseling and 41 out of 61 (67%) proceeded with testing and post-test counseling. A total of 4 out of 41 (10%) mutation carriers were identified: BRCA2, MSH2, and PMS2. Patients reported many advantages (eg, lower travel burden and convenience) and few disadvantages to RVC telegenetic services. Most patients reported feeling comfortable with the video camera—post-V1: 52/57 (91%); post-V2: 39/41 (95%)—and that their privacy was respected—post-V1: 56/57 (98%); post-V2: 40/41 (98%); however, some reported concerns that RVC might increase the risk of a confidentiality breach of their health information—post-V1: 14/57 (25%); post-V2: 12/41 (29%). While the majority of patients reported having no trouble seeing or hearing the genetic counselor—post-V1: 47/57 (82%); post-V2: 39/41 (95%)—51 out of 98 (52%) patients reported technical difficulties. Nonetheless, all patients reported being satisfied with genetic services. Compared to baseline, knowledge increased significantly after pretest counseling (+1.11 mean score, P=.005); satisfaction with telegenetic (+1.74 mean score, P=.02) and genetic services (+2.22 mean score, P=.001) increased after post-test counseling. General anxiety and depression decreased after pretest (-0.97 mean anxiety score, P=.003; -0.37 mean depression score, P=.046) and post-test counseling (-1.13 mean anxiety score, P=.003; -0.75 mean depression score, P=.01); state anxiety and cancer-specific worry did not significantly increase.ConclusionsRemote videoconferencing telegenetic services are feasible, identify genetic carriers in community practices, and are associated with high patient satisfaction and favorable cognitive and affective outcomes, suggesting an innovative delivery model for further study to improve access to genetic providers and services. Potential barriers to dissemination include technology costs, unclear billing and reimbursement, and state requirements for provider licensure.

Primary care providers’ cancer genetic testing-related knowledge, attitudes, and communication behaviors: A systematic review and research agenda

“…PCPs could benefit from genetics-related electronic health record tools, and those in community settings could particularly benefit from a team-based approach that includes assistance of a genetic professional trained in risk assessment and communication. Future research to evaluate technology-based approaches that extend the reach of a limited genetics workforce, such as telegenetics, 76,77 telephone counseling, 78,79 and web-based case conferencing, 80 may address this need.…”

Implementation of a Carrier Screening Program in a High-Risk Undergraduate Student Population Using Digital Marketing, Online Education, and Telehealth

“…Offering counseling via phone or video conference gives participants flexibility in scheduling and affords tremendous convenience, as participants do not need to travel to an onsite appointment [13, 14]. These benefits have been recognized by the JScreen model [15] where the genetic counseling schedule also allows for evening and weekend appointments to maximize convenience.…”

Clinical models of telehealth in genetics: A regional telegenetics landscape

“…Collectively, these studies have demonstrated improved access to care in underserved areas with high levels of patient satisfaction and outcomes similar to in-person consultations across many patient populations and medical indications (Abrams & Geier, 2006;Bradbury et al, 2016;Buchanan et al, 2015;Coelho, Arnold, Nayler, Tischkowitz, & MacKay, 2005;D'Agincourt-Canning et al, 2008; on these varied approaches, and their associated patient outcomes, is also needed to inform program development.…”

“…When examining the literature specific to genetics consultation via live videoconferencing, the term “telegenetics,” is most often used, but the terms “virtual health” (Weissman, Zellmer, Gill, & Wham, 2018), “televideo” (Voils et al, ), and web‐based/video (National Society of Genetic Counselors, ) were also noted. Collectively, these studies have demonstrated improved access to care in underserved areas with high levels of patient satisfaction and outcomes similar to in‐person consultations across many patient populations and medical indications (Abrams & Geier, ; Bradbury et al, ; Buchanan et al, ; Coelho, Arnold, Nayler, Tischkowitz, & MacKay, ; D'Agincourt‐Canning et al, ; Fournier, Bazzell, & Dains, ; Gattas, MacMillan, Meinecke, Loane, & Wootton, ; Gray et al, ; Hardy & Grinzaid, ; Hawkins, Creighton, Ho, McManus, & Hayden, ; Hilgart et al, ; Hopper, Buckman, & Edwards, ; Kubendran, Sivamurthy, & Schaefer, ; Lea et al, ; Mette et al, ; Otten, Birnie, Lucassen, Ranchor, & van Langen, ; Schwartz et al, ; Solomons, Lamb, Lucas, McDonald, & Miesfeldt, ; Stalker et al, ; Sutphen et al, ; Weissman et al, ; Wenger et al, ; Zilliacus et al, ; Zilliacus, Meiser, Lobb, Kirk, et al, ). Some studies have shown reductions in cost and time per patient for the clinic and/or the patient (Buchanan et al, ; D'Agincourt‐Canning et al, ; Otten, Birnie, Ranchor, & van Langen, ; Schwartz et al, ; Weissman et al, ), shorter wait times (Cohen et al, ; Kubendran et al, ; Stalker et al, ; Weissman et al, ), and a larger geographic reach (Cohen et al, ).…”