For cancer patients, genetic counseling has become a standard of care at academic medical centers, but community-based medical centers often lack access to such resources. A new study, presented at the American Society of Clinical Oncology Annual Meeting this week, suggests that telemedicine counseling may help bridge that gap.
Genetic counselors can help patients understand how familial and genetic risks contribute to cancer risk, guide patients through the testing process, and assist patients with interpreting test results and what they mean for a patient’s healthcare. The testing helps physicians identify high-risk patients who may benefit from additional screening or cancer prevention interventions. Academic medical centers often have access to genetic service providers; smaller community practices do not.
To explore whether telemedicine counseling could improve access to genetic testing, researchers from the Basser Center for BRCA at the University of Pennsylvania’s Abramson Cancer Center conducted a randomized, controlled trial giving patients either telemedicine counseling or traditional care, which consisted of being provided information on how to obtain genetic testing. In the traditional care group, patients who wanted genetic counseling would have to drive to a center with a genetic counselor. Although the study is still ongoing, the researchers have analyzed the data for the 115 patients who have already reached the study endpoint.
After six months, 77 percent of the patients offered telemedicine counseling had completed counseling; only 6 percent of the control group completed counseling. And 55 percent of the patients in the test group did proceed to get genetic testing, while 17 percent of the patients in the traditional care group obtained genetic testing.
Telemedicine counseling can clearly enhance the care provided by community practices, conclude the study authors, though more research is needed. However, the fact that nearly half of the patients who were offered telemedicine counseling forewent genetic testing indicates that more work is required to help patients understand the potentially life-saving information.
The opposite situation presented in the traditional care group—patients are getting genetic testing without going through counseling first, which, as shown by previous studies, tends to lead to lower satisfaction and lower levels of knowledge. One wonders if the inconvenience of driving to appointments with a genetic counselor discourages patients from pursuing counseling; if so, then telemedicine counseling could be a viable alternative at academic medical centers, especially for patients who do not travel easily. With healthcare delivery shifting toward patient-centered care, that includes all patients, not just patients in remote communities. After all, if healthcare were convenient, who wouldn’t want it?