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Genetic counseling by phone or face-to-face


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Results presented at the 2017 American Psychological Association’s annual meeting showed genetic counseling by telephone is as “safe and effective” in long-term psychological and social outcomes compared to traditional in-person counseling for women at risk for hereditary breast and ovarian cancer. This presentation is an update on research published in 2014. (11/29/17)


STUDY AT A GLANCE

This study is about:

Long-term psychological and social outcomes from genetic counseling by phone compared to in-person counseling.

Background:

Research has shown the benefits of genetic counseling for people undergoing genetic testing for cancer risk. Traditionally genetic counseling has involved a face-to-face appointment. Experts have explored new models for delivering genetic counseling remotely, including offering this service by telephone. The researchers involved in this study previously compared outcomes 2 weeks and 3 months post-counseling for women who received genetic counseling by telephone versus in-person. This new research reports the results of the 12 month follow-up for this study.

Why is this study important?

As genetic testing becomes more common, demand for in-person genetic counseling will exceed the resources genetic counselors have to provide information and support to patients.  Telephone genetic counseling allows genetic counselors to deliver needed information in a timely manner, is often cheaper, and provides a way to serve patients who cannot travel to a genetic counselor.   

Researchers wanted to make sure that telephone genetic counseling is safe and effective in long-term psychological and social outcomes compared to traditional in-person counseling for women at risk for hereditary breast and ovarian cancer.

Study findings:

At the 12-month follow-up, women counseled by telephone showed clear evidence of similar outcomes compared to women receiving in-person counseling on five outcomes measured:

  • distress
  • quality of life
  • knowledge
  • decisional conflict 
  • satisfaction 

Because these results suggest that telephone counseling is safe and effective for women at high risk of hereditary breast and ovarian cancer, the authors encourage providers to consider telemedicine genetic counseling as an alternative to in-person counseling.  

What does this mean for me?

While the idea of delivering bad news related to one’s health via phone has been a subject of debate, this study shows that a carefully controlled telephone counseling program provides similar psychological and social outcomes for patients compared to in-personal counseling. Genetic counseling by telephone may increase access to a genetic counselor (which may take months to schedule) and may cost less than in-person counseling.

Questions to ask your health care provider

  • What are the pros and cons of genetic counseling by phone versus seeing a genetics counselor in-person?
  • Can you provide me with the names of genetic counselors who provide this service by telephone?

IN DEPTH REVIEW OF RESEARCH

Study background:

Telephone delivery of genetic counseling is an alternative to in-person genetic counseling because it may extend the reach of genetic counseling services. Previous reports have established that telephone counseling is as effective as in-person counseling for both short-term psychosocial and decision-making outcomes. In the current study, researchers examined the long-term impact of telephone counseling (TC) vs in-person counseling (usual care - UC). 

Researchers of this study wanted to know:

Is genetic counseling by telephone as safe and effective as in-person counseling for patients at high risk of breast and ovarian cancer?

Study design and population

A multi-site, randomized, trial conducted from 2004-2012 enrolled 669 participants (women age 21 to 85 who did not have a newly diagnosed or metastatic cancer and lived within a study site area).  Participants were randomly assigned to usual care of in-person genetic counseling (UC; n = 334) or telephone counseling (TC; n = 335). UC participants received in-person pre- and post-test counseling; TC participants completed all genetic counseling by telephone.

Primary outcomes were patient-reported satisfaction with genetic testing decisions, distress, quality of life, knowledge, and decisional conflict satisfaction compared to women receiving in-person counseling. Outcomes were measured by a trained research assistant who called participants to administer a verbal consent and complete follow-up surveys two weeks after counseling (pretest disclosure) and three, six, and 12 months after random assignment (TC or UC). 512 participants completed the 12-month follow-up. 

Study findings

At the 2017 American Psychological Association’s annual meeting, Marc Schwartz, of Georgetown University’s Lombardi Comprehensive Cancer Center, presented results of the 12 month follow-up:  In-Person Genetic Counseling for Hereditary Breast and Ovarian Cancer: A 12-Month Follow-Up to his 2014 study: “Randomized Noninferiority Trial of Telephone Versus In-Person Genetic Counseling for Hereditary Breast and Ovarian Cancer”. This was one of the first studies to show comparable outcomes," said Schwartz, “That's important not only for these at-risk women, but also because "as testing becomes more popular for other cancers, there's just not enough capacity to see (everyone) in person."

Limitations:

At the 12 month follow-up researchers noted the following study limitations:

  • TC yielded lower rates of genetic testing compared with UC.
  • Study of TC in more diverse populations is needed given the low rate of minority participants in this study.
  • Researchers did not collect data on those who declined to participate in TC which prevented them from understanding what factors contributed to willingness to participate in TC.
  • The complexity of genetic counseling has increased since this trial. Whether telephone delivery is effective for more complex genetic testing  is unknown.
  • The evaluation of risk management outcomes relied on self-report measures and could be improved in future studies with verification of clinical records.

Conclusions:

There is now strong evidence from multiple studies that patients who receive genetic counseling over the telephone have short- and long-term outcomes that are no worse than patients who receive in-person genetic counseling. In addition, there is no evidence that telephone counseling yields lower rates of uptake of recommended risk-reducing surgery or breast cancer screening among mutation carriers. However, these are not the only important outcomes of genetic counseling. For example, this study did not determine whether or not patients felt they received enough information about the pros and cons of genetic testing to make an informed decision nor did this study evaluate whether or not patients felt they received adequate psychological support by phone. However, the results of this long-term study support the conclusion that TC is safe and effective and may be considered for patients who cannot afford or cannot travel to genetic counseling centers.

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Posted 11/29/17

References:

Schwartz MD, Valdimarsdottir HB, Peshkin BN, Mandelblatt J, Nusbaum R, Huang A-T, Chang Y, Graves K, Isaacs C, Wood M, McKinnon W, Garber J, McCormick S, Kinney AY, Luta G, Kelleher S, Leventhal K-G, Vegella O, Tong A and King L. Randomized Noninferiority Trial of Telephone Versus In-Person Genetic Counseling for Hereditary Breast and Ovarian Cancer. Journal of Clinical Oncology. 2014. 32:7, 618-626.

Interrante MK, Segal H,  Peshkin BN,  Valdimarsdottir HB,  Nusbaum R, Similuk M, DeMarco T, Hooker G, Graves K, Isaacs C, Wood M, McKinnon W, Garber J, McCormick S, Heinzmann J, Kinney AY and Schwartz MD.  In-Person Genetic Counseling for Hereditary Breast and Ovarian Cancer: A 12-Month Follow-Up. JNCI Cancer Spectrum.  2017. 1:1.

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