title: Randomized Trial of Telegenetics vs. In-Person Cancer Genetic Counseling: Cost, Patient Satisfaction and Attendance.
abstract: Telegenetics-genetic counseling via live videoconferencing-can improve access to cancer genetic counseling (CGC) in underserved areas, but studies on cancer telegenetics have not applied randomized methodology or assessed cost. We report cost, patient satisfaction and CGC attendance from a randomized trial comparing telegenetics with in-person CGC among individuals referred to CGC in four rural oncology clinics. Participants (n = 162) were randomized to receive CGC at their local oncology clinic in-person or via telegenetics. Cost analyses included telegenetics system; mileage; and personnel costs for genetic counselor, IT specialist, and clinic personnel. CGC attendance was tracked via study database. Patient satisfaction was assessed 1 week post-CGC via telephone survey using validated scales. Total costs were $106 per telegenetics patient and $244 per in-person patient. Patient satisfaction did not differ by group on either satisfaction scale. In-person patients were significantly more likely to attend CGC than telegenetics patients (89 vs. 79 %, p = 0.03), with bivariate analyses showing an association between lesser computer comfort and lower attendance rate (Chi-square = 5.49, p = 0.02). Our randomized trial of telegenetics vs. in-person counseling found that telegenetics cost less than in-person counseling, with high satisfaction among those who attended. This study provides support for future randomized trials comparing multiple service delivery models on longer-term psychosocial and behavioral outcomes.
authors.affiliation: Genomic Medicine Institute, Geisinger Health System, M.C. 26-20, 100 N. Academy Ave., Danville, PA, 17822, USA. ahbuchanan@geisinger.edu.
authors.forename: Adam H
authors.initials: AH
authors.lastname: Buchanan
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, NC, USA.|Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, USA.
authors.forename: Santanu K
authors.initials: SK
authors.lastname: Datta
authors.affiliation: Department of Clinical Sciences and Harold C Simmons Cancer Center, University of Texas - Southwestern, Dallas, TX, USA.
authors.forename: Celette Sugg
authors.initials: CS
authors.lastname: Skinner
authors.affiliation: Department of Biology, North Carolina Central University, Durham, NC, USA.
authors.forename: Gail P
authors.initials: GP
authors.lastname: Hollowell
authors.affiliation: School of Nursing, Duke University Medical Center, Durham, NC, USA.
authors.forename: Henry F
authors.initials: HF
authors.lastname: Beresford
authors.affiliation: Office of Information Technology, Duke University, Durham, NC, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Freeland
authors.affiliation: Department of Medicine, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Rogers
authors.affiliation: School of Nursing, Duke University Medical Center, Durham, NC, USA.
authors.forename: John
authors.initials: J
authors.lastname: Boling
authors.affiliation: Genomic Medicine Institute, Geisinger Health System, M.C. 26-20, 100 N. Academy Ave., Danville, PA, 17822, USA.|Department of Medicine, Duke University Medical Center, Durham, NC, USA.
authors.forename: P Kelly
authors.initials: PK
authors.lastname: Marcom
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, NC, USA.
authors.forename: Martha B
authors.initials: MB
authors.lastname: Adams
mesh_terms: D000368:Aged; D000554:Ambulatory Care Facilities; D000068237:Distance Counseling / Q000191:economics* / Q000379:methods; D005260:Female; D005817:Genetic Counseling / Q000191:economics* / Q000379:methods; D005820:Genetic Testing; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis / Q000191:economics*; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D019035:Rural Health Services / Q000191:economics; D017216:Telemedicine / Q000191:economics* / Q000379:methods
keywords: Cancer genes; Cost analysis; Genetic counseling; Patient satisfaction; Telemedicine
references.citation: Med Care. 1988 Apr;26(4):393-402
references.pmid: 3352332
references.citation: Patient Educ Couns. 1997 Sep-Oct;32(1-2):51-62
references.pmid: 9355572
references.citation: J Genet Couns. 2004 Apr;13(2):83-114
references.pmid: 15604628
references.citation: Genet Med. 2005 Jan;7(1):21-7
references.pmid: 15654224
references.citation: Patient Educ Couns. 2005 Feb;56(2):182-91
references.pmid: 15653247
references.citation: Genet Test. 2005 Summer;9(2):167-74
references.pmid: 15943558
references.citation: Ann Intern Med. 2005 Sep 6;143(5):355-61
references.pmid: 16144894
references.citation: Eur J Cancer. 2005 Oct;41(15):2257-61
references.pmid: 16176873
references.citation: Fam Cancer. 2006;5(1):61-75
references.pmid: 16528610
references.citation: JAMA. 2006 Sep 27;296(12):1479-87
references.pmid: 17003396
references.citation: Telemed J E Health. 2008 Sep;14(7):720-5
references.pmid: 18817503
references.citation: J Genet Couns. 2004 Aug;13(4):293-304
references.pmid: 19736695
references.citation: Telemed J E Health. 2010 Apr;16(3):350-7
references.pmid: 20406122
references.citation: Fam Cancer. 2010 Sep;9(3):459-68
references.pmid: 20140525
references.citation: J Genet Couns. 2010 Oct;19(5):463-72
references.pmid: 20411313
references.citation: Genet Med. 2011 Nov;13(11):933-41
references.pmid: 21799430
references.citation: Genet Med. 2012 Sep;14(9):765-76
references.pmid: 22498847
references.citation: J Clin Oncol. 2014 Mar 1;32(7):618-26
references.pmid: 24449235
references.citation: J Telemed Telecare. 2000;6(4):245-7
references.pmid: 11027129
references.citation: Am J Med Genet. 2002 Jan 15;107(2):143-50
references.pmid: 11807889
references.citation: Br J Cancer. 2002 Jan 7;86(1):43-50
references.pmid: 11857010
references.citation: J Clin Oncol. 2002 Jun 1;20(11):2701-12
references.pmid: 12039933
references.citation: Oncol Nurs Forum. 2002 Jul;29(6):E77-84
references.pmid: 12096298
references.citation: Cancer. 2003 Jan 1;97(1 Suppl):236-45
references.pmid: 12491487
references.citation: J Clin Oncol. 2003 Jun 15;21(12):2397-406
references.pmid: 12692171
references.citation: Arch Surg. 2003 Dec;138(12):1323-8; discussion 1329
references.pmid: 14662532
references.citation: J Clin Oncol. 2004 Jan 1;22(1):39-44
references.pmid: 14701766
references.citation: J Med Genet. 2004 Feb;41(2):81-91
references.pmid: 14757853
references.citation: J Clin Oncol. 2004 May 15;22(10):1823-9
references.pmid: 15067026