There has been tremendous increase in genetic testing, primarily for BRCA 1/2 partly due to the “Angelina Jolie effect” and partly as we become more sophisticated about our move toward a personalized medicine model. This has created a real demand for genetic counselors to impart this important and very private information to patients.
In our own setting, it was difficult to recruit a genetic counselor to our service and we considered a telephone based way to counsel and discuss follow-up results with our breast cancer patients.
A recent study published in the Journal of Clinical Oncology caught my attention.1 We had the same concerns about the quality and accessibility of using telephone counseling as opposed to the face-to-face contact. Is the use of the telephone noninferior to the face-to-face counseling we sought? Apparently it is.
By use of a randomized noninferiority trial of telephone delivery of BRCA1/2 genetic counseling, they identified and recruited survivors of breast and ovarian cancer using the Utah Population Database and the Utah Cancer Registry. These women were then randomly assigned 495 survivors to in-person interviews and 493 patients to telephone counseling. The same genetic counselor who performed the pretest counseling delivered post-test counseling, and all participants were mailed a letter “summarizing their personalized risk assessment based on family history and/or genetic test result and management recommendations.1
At 1-year follow-up, “telephone counseling was noninferior to in-person counseling for all psychosocial and informed decision-making outcomes,” including anxiety, cancer-specific distress, perceived personal control, and decisional conflict. Fewer women who underwent telephone counseling opted to take the BRCA1/2 test (27.9%), in contrast with 37.3% for those counseled in person, with uptake higher among rural than urban residents in both groups. “Women reported similar levels of satisfaction and patient-centered care."1
These findings may help to change insurance policy guidelines which currently do not cover telephone counseling. Slowly, there is an increase in third-party reimbursement, which will give greater access to those needing genetic services, particularly for those patients with transportation, child care, or lack of internet skills issues.
It is not clear whether telephone counseling is noninferior for women who test BRCA1/2 positive, have variants of uncertain significant, and seek multigene testing.1
Has anyone been faced with the possibility of hiring a genetic counselor or using telemedicine? If so, did patients perceive this consultation in a positive way?
- Kinney AY, Steffen LE, Brumbach BH, et al. Randomized Noninferiority Trial of Telephone Delivery of BRCA1/2 Genetic Counseling Compared With In-Person Counseling: 1-Year Follow-Up. J Clin Oncol., 2016 Jun 20.