title: Utilizing Remote Real-Time Videoconferencing to Expand Access to Cancer Genetic Services in Community Practices: A Multicenter Feasibility Study.
abstract: BACKGROUND
  Videoconferencing 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.
  
  
  OBJECTIVE
  To 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.
  
  
  METHODS
  Patients 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.
  
  
  RESULTS
  A 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.
  
  
  CONCLUSIONS
  Remote 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.
authors.affiliation: Division of Hematology-Oncology, Department of Medicine, The University of Pennsylvania, Philadelphia, PA, United States. angela.bradbury@uphs.upenn.edu.
authors.forename: Angela
authors.identifier: http://orcid.org/0000-0001-9607-6402
authors.initials: A
authors.lastname: Bradbury
authors.forename: Linda
authors.identifier: http://orcid.org/0000-0003-4315-8687
authors.initials: L
authors.lastname: Patrick-Miller
authors.forename: Diana
authors.identifier: http://orcid.org/0000-0002-7900-8560
authors.initials: D
authors.lastname: Harris
authors.forename: Evelyn
authors.identifier: http://orcid.org/0000-0002-5003-1812
authors.initials: E
authors.lastname: Stevens
authors.forename: Brian
authors.identifier: http://orcid.org/0000-0002-1633-799X
authors.initials: B
authors.lastname: Egleston
authors.forename: Kyle
authors.identifier: http://orcid.org/0000-0001-8943-0995
authors.initials: K
authors.lastname: Smith
authors.forename: Rebecca
authors.identifier: http://orcid.org/0000-0003-0900-3489
authors.initials: R
authors.lastname: Mueller
authors.forename: Amanda
authors.identifier: http://orcid.org/0000-0002-1617-0771
authors.initials: A
authors.lastname: Brandt
authors.forename: Jill
authors.identifier: http://orcid.org/0000-0001-7724-3471
authors.initials: J
authors.lastname: Stopfer
authors.forename: Shea
authors.identifier: http://orcid.org/0000-0002-0766-1798
authors.initials: S
authors.lastname: Rauch
authors.forename: Andrea
authors.identifier: http://orcid.org/0000-0003-4782-8908
authors.initials: A
authors.lastname: Forman
authors.forename: Rebecca
authors.identifier: http://orcid.org/0000-0001-8069-2040
authors.initials: R
authors.lastname: Kim
authors.forename: Dominique
authors.identifier: http://orcid.org/0000-0001-6374-0151
authors.initials: D
authors.lastname: Fetzer
authors.forename: Linda
authors.identifier: http://orcid.org/0000-0002-6911-0756
authors.initials: L
authors.lastname: Fleisher
authors.forename: Mary
authors.identifier: http://orcid.org/0000-0002-7490-6038
authors.initials: M
authors.lastname: Daly
authors.forename: Susan
authors.identifier: http://orcid.org/0000-0002-5914-7272
authors.initials: S
authors.lastname: Domchek
mesh_terms: D003153:Community Health Services / Q000379:methods*; D003695:Delivery of Health Care / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005817:Genetic Counseling / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000235:genetics*; D017060:Patient Satisfaction; D017216:Telemedicine / Q000379:methods*; D049269:Videoconferencing / Q000592:standards*
keywords: cancer genetics; dissemination and implementation; genetic counseling; genetic testing; health care delivery; telemedicine
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