title: Patient and genetic counselor perceptions of in-person versus telephone genetic counseling for hereditary breast/ovarian cancer.
abstract: Telephone genetic counseling (TC) for high-risk women interested in BRCA1/2 testing has been shown to yield positive outcomes comparable to usual care (UC; in-person) genetic counseling. However, little is known about how genetic counselors perceive the delivery of these alternate forms of genetic counseling. As part of a randomized trial of TC versus UC, genetic counselors completed a 5-item genetic counselor process questionnaire (GCQ) assessing key elements of pre-test sessions (information delivery, emotional support, addressing questions and concerns, tailoring of session, and facilitation of decision-making) with the 479 female participants (TC, N = 236; UC, N = 243). The GCQ scores did not differ for TC vs. UC sessions (t (477) = 0.11, p = 0.910). However, multivariate analysis showed that participant race/ethnicity significantly predicted genetic counselor perceptions (β = 0.172, p < 0.001) in that the GCQ scores were lower for minorities in TC and UC. Exploratory analyses suggested that GCQ scores may be associated with patient preference for UC versus TC (t (79) = 2.21, p = 0.030). Additionally, we found that genetic counselor ratings of session effectiveness were generally concordant with patient perceptions of the session. These data indicate that genetic counselors perceive that key components of TC can be delivered as effectively as UC, and that these elements may contribute to specific aspects of patient satisfaction. However, undefined process differences may be present which account for lower counselor perceptions about the effectiveness of their sessions with minority women (i.e., those other than non-Hispanic Whites). We discuss other potential clinical and research implications of our findings.
authors.affiliation: Department of Oncology, Lombardi Comprehensive Cancer Center, Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University Medical Center, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA.
authors.forename: Aryana S
authors.initials: AS
authors.lastname: Jacobs
authors.affiliation: Department of Oncology, Lombardi Comprehensive Cancer Center, Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University Medical Center, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA.
authors.forename: Marc D
authors.initials: MD
authors.lastname: Schwartz
authors.affiliation: Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA.|Department of Psychology, Reykjavik University, Reykjavik, Iceland.
authors.forename: Heiddis
authors.initials: H
authors.lastname: Valdimarsdottir
authors.affiliation: GeneDx, Gaithersburg, MD, USA.
authors.forename: Rachel H
authors.initials: RH
authors.lastname: Nusbaum
authors.affiliation: NextGxDx, Inc., Franklin, TN, USA.
authors.forename: Gillian W
authors.initials: GW
authors.lastname: Hooker
authors.affiliation: Cancer Genetic Counseling Program, Inova Translational Medicine Institute, Inova Health System, Falls Church, VA, USA.
authors.forename: Tiffani A
authors.initials: TA
authors.lastname: DeMarco
authors.affiliation: Carol G. Simon Cancer Center, Atlantic Health Systems, Summit, NJ, USA.
authors.forename: Jessica E
authors.initials: JE
authors.lastname: Heinzmann
authors.affiliation: Familial Cancer Program, University of Vermont Cancer Center, Burlington, VT, USA.
authors.forename: Wendy
authors.initials: W
authors.lastname: McKinnon
authors.affiliation: Center for Cancer Risk Assessment, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Shelley R
authors.initials: SR
authors.lastname: McCormick
authors.affiliation: Joan H. Marks Graduate Program in Human Genetics, Sarah Lawrence College, Yonkers, NY, USA.
authors.forename: Claire
authors.initials: C
authors.lastname: Davis
authors.affiliation: Department of Clinical Genetics, Risk Assessment Program, Fox Chase Cancer Center, Philadelphia, PA, USA.
authors.forename: Andrea D
authors.initials: AD
authors.lastname: Forman
authors.affiliation: Stanford Healthcare, Stanford Women's Cancer Center, Stanford, CA, USA.
authors.forename: Alexandra Perez
authors.initials: AP
authors.lastname: Lebensohn
authors.affiliation: Ambry Genetics, Aliso Viejo, CA, USA.
authors.forename: Emily
authors.initials: E
authors.lastname: Dalton
authors.affiliation: GeneDx, Gaithersburg, MD, USA.
authors.forename: Diana Moglia
authors.initials: DM
authors.lastname: Tully
authors.affiliation: Department of Oncology, Lombardi Comprehensive Cancer Center, Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University Medical Center, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA.
authors.forename: Kristi D
authors.initials: KD
authors.lastname: Graves
authors.affiliation: National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA.
authors.forename: Morgan
authors.initials: M
authors.lastname: Similuk
authors.affiliation: Department of Epidemiology and Biostatistics, George Washington University, Washington, DC, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Kelly
authors.affiliation: Department of Oncology, Lombardi Comprehensive Cancer Center, Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University Medical Center, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC, 20007, USA. peshkinb@georgetown.edu.
authors.forename: Beth N
authors.initials: BN
authors.lastname: Peshkin
mesh_terms: D001943:Breast Neoplasms / Q000235:genetics* / Q000523:psychology; D000072117:Counselors / Q000523:psychology; D005260:Female; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D005817:Genetic Counseling / Q000379:methods* / Q000523:psychology*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000235:genetics* / Q000523:psychology; D017060:Patient Satisfaction; D012959:Socioeconomic Factors; D013689:Telephone
keywords: BRCA1/BRCA2; Genetic counseling; Patient satisfaction; Telephone counseling