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

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Journal of Genetic Counseling

Abstract

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.

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Acknowledgements

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).

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Authors and Affiliations

  1. Department of Medical Oncology, Prince of Wales Hospital, Randwick, NSW, Australia

    Elvira Zilliacus

  2. School of Psychiatry, The University of New South Wales, Randwick, NSW, Australia

    Elvira Zilliacus

  3. Prince of Wales Clinical School, The University of New South Wales, Randwick, NSW, Australia

    Bettina Meiser

  4. Centre for Medical Psychology & Evidence-based Decision-making, University of Sydney, Sydney, NSW, Australia

    Elizabeth Lobb

  5. Centre for Cancer & Palliative Care, Curtin University of Technology, Perth, WA, Australia

    Elizabeth Lobb

  6. WA Centre for Cancer & Palliative Care, Edith Cowan University, Perth, WA, Australia

    Elizabeth Lobb

  7. Centre for Genetics Education, North Shore Hospital, St Leonards, NSW, Australia

    Kristine Barlow-Stewart

  8. Faculty of Medicine, University of Sydney, Sydney, NSW, Australia

    Katherine Tucker

  9. Psychosocial Research Group, Prince of Wales Hospital, Level 3, Dickinson Building, Randwick, NSW, 2031, Australia

    Elvira Zilliacus

Authors
  1. Elvira Zilliacus
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  2. Bettina Meiser
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  3. Elizabeth Lobb
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  4. Kristine Barlow-Stewart
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  5. Katherine Tucker
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Correspondence to Elvira Zilliacus.

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Zilliacus, E., Meiser, B., Lobb, E. et al. A Balancing Act—Telehealth Cancer Genetics and Practitioners’ Experiences of a Triadic Consultation. J Genet Counsel 18, 598–605 (2009). https://doi.org/10.1007/s10897-009-9247-7

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  • DOI: https://doi.org/10.1007/s10897-009-9247-7

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