Logistics and Uptake of Genetic Testing for Patients Referred for Telegenetic Counselling for Cancer

DOI: https://doi.org/10.29086/JISfTeH.6.e13

Keywords: telegenetic counseling, genetic testing, telemedicine, hereditary cancer, genetic counseling

Abstract

Purpose:  There is a dearth of information about the uptake of genetic testing after telegenetic (videoconference) counselling for hereditary cancer, which has been previously reported as a limitation of this service delivery model.  Methods:  We performed a review of the triage list for patients referred to The Ohio State University (OSU) from two community cancer centres for telegenetic counselling appointments from April 1, 2014 to May 31, 2016.  Results:  A total of 179 patients were referred for telegenetic counselling, and of   these 62.6% (112/179) completed a 30-60 minute telegenetic counselling appointment.   Of those counselled, 82.1% (92/112) completed genetic testing,    12.0% (11/92) of whom were found to have a pathogenic mutation.  Of those with mutations, 45.5% (5/11) returned for a follow-up telegenetic counselling session to review results in more detail.  In addition, 18.5% (17/92) of patients tested had at least one variant of uncertain significance (VUS). Conclusions:  The presence of a nurse/nurse practitioner with the patient at the remote site during the telegenetic counselling session may have facilitated higher completion rates for genetic testing compared to previous reports in the literature, and appropriateness of genetic testing in this method of providing genetic counselling is reflected in the rates of results identifying deleterious mutations and variants of uncertain significance.

Author Biography

Kate Parks Shane-Carson, The Ohio State University
Licensed Genetic Counselor Assistant Professor, Clinical Internal Medicine

References

Cohen SA, Marvin ML, Riley BD, et al. Identification of genetic counselling service delivery models in practice: a report from the NSGC Service Delivery Model Task Force. J Genet Counsell 2013;2(4):411–421. DOI:10.1007/s10897-013-9588-0.

Bradbury A, Patrick-Miller L, Harris D, et al. Utilizing remote real-time videoconferencing to expand access to cancer genetic services in community practices: a multicenter feasibility study. J Med Internet Res 2016;18(2):e23. DOI:10.2196/jmir.4564.

Buchanan AH, Datta S, Skinner CS, et al. Randomized trial of telegenetics vs. in-person cancer genetic counselling: cost, patient satisfaction and attendance. J Genet Counsell 2015;24(6):961–970.

Hilgart JS, Hayward JA, Coles B, Ireldale R. Telegenetics: a systematic review of telemedicine in genetics services. Genet Med 2012;14(9):765-776.

McDonald E, Lamb A, Grillo B, Lucas L, Miesfeldt S. Acceptability of telemedicine and other cancer genetic counselling models of service delivery in geographically remote settings. J Genet Counsell 2014;23(2):221–228.

Mette LA, Saldívar AM, Poullard NE, et al. Reaching high-risk underserved individuals for cancer genetic counselling by video-teleconferencing. J Community Support Oncol 2016;14(4):162-168.

Portigal-Tood C. Impact of telegenetics and alternative models of care on hereditary cancer genetic counselling in British Columbia. Estudos 2014;Goiania,41(especial):13-33.

Zilliacus E, Meiser B, Lobb E, et al. Women’s experience of telehealth cancer genetic counselling. J Genet Counsell 2010;19(5):463–472. DOI:10.1007/s10897-010-9301-5.

Zillacus EM, Meiser B, Lobb EA, et al. Are videoconferenced consultations as effective as face-to-face consultations for hereditary breast and ovarian cancer genetic counselling? Genet Med 2011;13(11):933-941.

American College of Surgeons Commission on Cancer. Cancer program standards: ensuring patient-centered care. (2016) Available at: https://www.facs.org/~/media/files/quality%20programs/cancer/coc/2016%20coc%20standards%20manual_interactive%20pdf.ashx accessed 5May 2018.

American College of Surgeons Commission on Cancer. NAPBC standards manual. (2014) Available at: https://www.facs.org/~/media/files/quality%20programs/napbc/2014%20napbc%20standards%20manual.ashx accessed 5May 2018.

Cigna. Genetic testing and counselling program: genetic counselling requirement. (2018) Available at: https://www.cigna.com/healthcare-professionals/resources-for-health-care-professionals/genetic-testing-and-counseling-program accessed 9 May 2018.

Medical Mutual. Prior approval and investigational services. Available at: https://provider.medmutual.com/pdf/priorapprovallist.pdf accessed 9 May 2018.

United HealthCare Services. Genetic testing for hereditary breast and/or ovarian cancer syndrome (HBOC). Medical Policy 04/01/2017. (2017) Available at: https://www.oxhp.com/secure/policy/genetic_testing_for_hereditary_breast_and_or_ovarian_cancer_syndrome_hboc.pdf accessed 9 May 2018.

Cohen SA, Huziak RC, Gustafson S, Grubs RE. Analysis of advantages, limitations, and barriers of genetic counselling service delivery models. J Genet Counsell 2016;25(5):1010-1018. DOI:10.1007/s10897-016-9932-2.

Zilliacus EM, Meiser B, Lobb E, et al. The virtual consultation: practitioners’ experiences of genetic counselling by videoconferencing in Australia. Telemed J e-Health 2010;16(3):350–357. DOI:10.1089/tmj.2009.0108.

Scheuner MT, Marshall N, Lanto A, et al. Delivery of clinical genetic consultative services in the Veterans Health Administration. Genet Med 2014;16(8):609–619.

Meropol NJ, Daly MB, Vig HS, et al. Delivery of internet-based cancer genetic counselling services to patients’ homes: a feasibility study. J Telemed Telecare 2011;17(1):36–40. DOI:10.1258/jtt.2010.100116.

Elliott AM, Mhanni AA, Marles SL, et al. Trends in telehealth versus on-site clinical genetics appointments in Manitoba: a comparative study. J Genet Counsell 2012;21(2):337–344.

Butrick M, Kelly S, Peshkin BN, et al. Disparities in uptake of BRCA1/2 genetic testing in a randomized trial of telephone counselling. Genet Med 2015;17(6):467-475.

Susswein LR, Marshall ML, Nusbaum R, et al. Pathogenic and likely pathogenic variant prevalence among the first 10,000 patients referred for next-generation cancer panel testing. Genet Med 2015;18(8):823-832. DOI:10.1038/gim.2015.166.

Published
2018-05-28
How to Cite
Shane-Carson, K., & Martin, C. (2018). Logistics and Uptake of Genetic Testing for Patients Referred for Telegenetic Counselling for Cancer. Journal of the International Society for Telemedicine and EHealth, 6(1), e13 (1-7). https://doi.org/10.29086/JISfTeH.6.e13
Section
Original Research