Journal of Genetic Counseling

, 18:598 | Cite as

A Balancing Act—Telehealth Cancer Genetics and Practitioners’ Experiences of a Triadic Consultation

  • Elvira Zilliacus
  • Bettina Meiser
  • Elizabeth Lobb
  • Kristine Barlow-Stewart
  • Katherine Tucker
Original Research


Telehealth is increasingly used for outreach service in cancer genetic counseling; however what occurs during the consultation and the roles practitioners adopt is largely unknown. Fifteen practitioners participated in semi-structured interviews that explored their roles within telehealth, compared to face-to-face consultations, and the relationship between practitioners during telehealth. As they were not physically present with the patient, most participants felt that telehealth altered the genetic clinician’s role to one of a ‘visiting specialist’. Genetic counselors described undertaking multiple roles during the telehealth process. Two models of interaction were observed. The medical model reduced the interaction to a dyadic consultation by having the genetic counselor off-screen and included minimal clinician meetings and supervision. The triadic co-facilitation model incorporated a high level of information exchange, counselor autonomy and included the counselor onscreen. The co-facilitation model offers a useful framework for telehealth genetic counselling, offering complementary roles between practitioners and efficient service delivery.


Genetic counseling Telehealth Cancer Triadic relationship 



We are most grateful for the valuable contribution of all the genetic counselors and genetic clinicians who participated in the project as informants and to Dr Shab Mireskandari, Dr Tracey Dudding, Associate Professor Judy Kirk and Ms Linda Warwick for their input into the development of this project. A/Professor Bettina Meiser is supported by an NHMRC Career Development Award (ID 350989). This research was funded through a Strategic Research Partnership Grant from the New South Wales Cancer Council (SRP 06-X5).


  1. Australian Commonwealth Department of Health and Ageing. (2008). Private Health Insurance Administration Council. Retrieved October 10, 2008, from
  2. Bensing, J., Dulmen, S. V., & Tates, K. (2003). Communication in context: new directions in communication research. Pat Ed Couns, 50, 27–32.Google Scholar
  3. Gattas, M., MacMillan, J., Meinecke, I., Loane, M., & Wootton, R. (2001). Telemedicine and clinical genetics: establishing a successful service. Journal of Telemedicine and Telecare, 7(supp 2), 68–70.CrossRefPubMedGoogle Scholar
  4. Hu, P., & Chau, P. (1999). Physician acceptance of telemedicine technology: an empirical investigation. Top Health Inform Manage, 19(4), 20–35.Google Scholar
  5. Iredale, R., Gray, J., & Murtagh, G. (2002). Telegenetics: a pilot study of video-mediated genetic consultations in Wales. International Journal of Medical Marketing, 2(2), 130–135.CrossRefGoogle Scholar
  6. Kessler, S. (1997). Psychological aspects of genetic counseling IX: teaching and counseling. Journal of Genetic Counseling, 6(3), 287–295.CrossRefGoogle Scholar
  7. Mairinger, T., Gabl, C., Derwan, P., Mikuz, G., & Ferrer-Roca, O. (1996). What do physicians think of telemedicine? a survey in different European regions. International Journal of Medical Marketing, 2, 50–56.Google Scholar
  8. Meiser, B., Gaff, C., Julian-Reynier, C., Biesecker, B., Esplen, M. J., Vodermaier, A., et al. (2006, 2007). International perspectives on genetic counseling and testing for breast cancer risk. Breast Disease, 27, 109–125.PubMedGoogle Scholar
  9. Miles, M., & Huberman, M. (1984). Qualitative data analysis: A sourcebook for new methods. Beverly Hills CA: Sage.Google Scholar
  10. Savenstedt, S., Bucht, G., Norberg, L., & Sandman, P. (2002). Nurse-doctor interaction in teleconsultations between a hospital and a geriatric nursing home. Journal of Telemedicine and Telecare, 8, 11–18.CrossRefPubMedGoogle Scholar
  11. Tates, K., Elbers, I., Meeuwesen, L., & Bensing, J. (2002). Doctor-parent-child relationships’: a ‘pas de trois’. Pat Ed Couns, 48, 5–14.CrossRefGoogle Scholar
  12. Torppa, M., Timonen, O., Keinanen-Kiukaanniemi, S., Larivaara, P., & Leiman, M. (2006). Patient-nurse-doctor interaction in general practice teleconsultations - a qualitative analysis. Journal of Telemedicine and Telecare, 12(6), 306–310.CrossRefPubMedGoogle Scholar
  13. Vandulmen, A. M. (1998). Children’s contribution to pediatric outpatient encounters. Pediatrics, 102, 563–568.CrossRefGoogle Scholar

Copyright information

© National Society of Genetic Counselors, Inc. 2009

Authors and Affiliations

  • Elvira Zilliacus
    • 1
    • 2
    • 9
  • Bettina Meiser
    • 3
  • Elizabeth Lobb
    • 4
    • 5
    • 6
  • Kristine Barlow-Stewart
    • 7
  • Katherine Tucker
    • 8
  1. 1.Department of Medical OncologyPrince of Wales HospitalRandwickAustralia
  2. 2.School of PsychiatryThe University of New South WalesRandwickAustralia
  3. 3.Prince of Wales Clinical SchoolThe University of New South WalesRandwickAustralia
  4. 4.Centre for Medical Psychology & Evidence-based Decision-makingUniversity of SydneySydneyAustralia
  5. 5.Centre for Cancer & Palliative CareCurtin University of TechnologyPerthAustralia
  6. 6.WA Centre for Cancer & Palliative CareEdith Cowan UniversityPerthAustralia
  7. 7.Centre for Genetics EducationNorth Shore HospitalSt LeonardsAustralia
  8. 8.Faculty of MedicineUniversity of SydneySydneyAustralia
  9. 9.Psychosocial Research GroupPrince of Wales HospitalRandwickAustralia

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