Abstract
In 2009, the National Society of Genetic Counselors Service (NSGC) Delivery Model Task Force defined genetic counseling service delivery models including telephone (genetic counseling provided remotely by telephone) and telegenetics (counseling provided remotely using videoconferencing). Little is known about the experience of genetic counselors practicing telemedicine in the USA. We sought to evaluate perceived satisfaction, advantages, disadvantages, and barriers to the practice and implementation of telegenetics by practicing genetic counselors. A 21-question online survey was distributed via the NSGC’s member directory. Descriptive statistics and a thematic analysis were used to analyze data. A total of 344 surveys were completed of which 235 (68.3%) respondents had delivered genetic counseling via telemedicine and 109 (36.6%) had not. Overall genetic counseling providers who had provided telegenetics were satisfied or very satisfied with their position (91%) and those who were not performing telegenetics were at least slightly interested in a telehealth position (92%).The most common appealing reasons for working in or wanting to work in telemedicine included an innovative approach to healthcare delivery, aspects of remote positions such as the ability to work from home, and flexibility of hours. Unappealing characteristics of telemedicine included the inability to see nonverbals, limited psychosocial counseling, and limited social interaction with colleague that is associated with remote positions. Barriers to implementation of telegenetics were noted by 53% of respondents with the largest barrier being billing and reimbursement. The results of this work suggest that telegenetics service organizations could consider increasing social interactions, attempting to use the preferred method of care (video) to increase ability to see nonverbals, offering flexible work hours, and allowing time to address psychosocial issues as they arise in consultations.
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References
Abrams, D. J., & Geier, M. R. (2006). A comparison of patient satisfaction with telehealth and on-site consultations: a pilot study for prenatal genetic counseling. Journal of Genetic Counseling, 15(3), 199–205. https://doi.org/10.1007/s10897-006-9020-0.
Baumanis, L., Evans, J. P., Callanan, N., & Susswein, L. R. (2009). Telephoned BRCA1/2 genetic test results: Prevalence, practice, and patient satisfaction. Journal of Genetic Counseling, 18(5), 447–463. https://doi.org/10.1007/s10897-009-9238-8.
Buchanan, A. H., Datta, S. K., Skinner, C. S., Hollowell, G. P., Beresford, H. F., Freeland, T., …, Adams, M. B. (2015). Randomized trial of Telegenetics vs. in-person cancer genetic counseling: Cost, Patient Satisfaction and Attendance. Journal of Genetic Counseling, 24(6), 961–970. https://doi.org/10.1007/s10897-015-9836-6.
Burgess, K. R., Carmany, E. P., & Trepanier, A. M. (2016). A comparison of telephone genetic counseling and in-person genetic counseling from the genetic Counselor’s perspective. Journal of Genetic Counseling, 25(1), 112–126. https://doi.org/10.1007/s10897-015-9848-2.
Cisco. (2013). Global Customer Experience Report Focused on Health Care Demonstrate Shift in Consumer Attitudes Toward Personal Data, Telemedicine and Access to Medical Information. Retrieved from https://newsroom.cisco.com/press-release-content?type=webcontent&articleId=1148539.
Coelho, J. J., Arnold, A., Nayler, J., Tischkowitz, M., & MacKay, J. (2005). An assessment of the efficacy of cancer genetic counselling using real-time videoconferencing technology (telemedicine) compared to face-to-face consultations. European Journal of Cancer (Oxford, England : 1990), 41(15), 2257–2261. https://doi.org/10.1016/j.ejca.2005.06.020.
Cohen, S. A., Gustafson, S. L., Marvin, M. L., Riley, B. D., Uhlmann, W. R., Liebers, S. B., & Rousseau, J. A. (2012). Report from the National Society of genetic counselors service delivery model task force: A proposal to define models, components, and modes of referral. Journal of Genetic Counseling, 21(5), 645–651. https://doi.org/10.1007/s10897-012-9505-y.
Cohen, S. A., Marvin, M. L., Riley, B. D., Vig, H. S., Rousseau, J. A., & Gustafson, S. L. (2013). Identification of genetic counseling service delivery models in practice: A report from the NSGC Service delivery model task force. Journal of Genetic Counseling, 22(4), 411–421. https://doi.org/10.1007/s10897-013-9588-0.
D’Agincourt-Canning, L., McGillivray, B., Panabaker, K., Scott, J., Pearn, A., Ridge, Y., & Portigal-Todd, C. (2008). Evaluation of genetic counseling for hereditary cancer by videoconference in British Columbia. BC Medical Journal, 50(10), 554–559.
Gallup (2017). State of the American Workplace. Retrieved June 1, 2017, from http://www.gallup.com/services/178514/state-american-workplace.aspx.
Gattas, M. R., MacMillan, J. C., Meinecke, I., Loane, M., & Wootton, R. (2001). Telemedicine and clinical genetics: Establishing a successful service. Journal of Telemedicine and Telecare, 7(suppl 2), 68–70. https://doi.org/10.1258/1357633011937191.
Helmes, A. W., Culver, J. O., & Bowen, D. J. (2006). Results of a randomized study of telephone versus in-person breast cancer risk counseling. Patient Education and Counseling, 64(1–3), 96–103. https://doi.org/10.1016/j.pec.2005.12.002.
Hilgart, J. S., Hayward, J. A., Coles, B., & Iredale, R. (2012). Telegenetics: A systematic review of telemedicine in genetics services. Genetics in Medicine : Official Journal of the American College of Medical Genetics, 14(9), 765–776. https://doi.org/10.1038/gim.2012.40.
Hopp, F., Whitten, P., Subramanian, U., Woodbridge, P., Mackert, M., & Lowery, J. (2006). Perspectives from the veterans health administration about opportunities and barriers in telemedicine. Journal of Telemedicine and Telecare, 12(8), 404–409. https://doi.org/10.1258/135763306779378717.
Jennett, P. A., Affleck Hall, L., Hailey, D., Ohinmaa, A., Anderson, C., Thomas, R., …, Scott, R. E. (2003). The socio-economic impact of telehealth: A systematic review. Journal of Telemedicine and Telecare, 9(6), 311–20. https://doi.org/10.1258/135763303771005207.
Kubendran, S., Sivamurthy, S., & Schaefer, G. B. (2017). A novel approach in pediatric telegenetic services: Geneticist, pediatrician and genetic counselor team. Genet in Medicine. https://doi.org/10.1038/gim.2017.45.
Latest Telecommuting Statistics. (2017). Global workplace analytics. http://globalworkplaceanalytics.com/telecommuting-statistics. Accessed 1/3/18.
Lea, D. H., Johnson, J. L., Ellingwood, S., Allan, W., Patel, A., & Smith, R. (2005). Telegenetics in Maine: Successful clinical and educational service delivery model developed from a 3-year pilot project. Genetics in Medicine: Official Journal of the American College of Medical Genetics, 7(1), 21–27. https://doi.org/10.1097/01.GIM.0000151150.20570.E7.
Marcus, A. C., Garrett, K. M., Kulchak-Rahm, A., Barnes, D., Dortch, W., & Juno, S. (2002). Telephone counseling in psychosocial oncology: A report from the cancer information and counseling line. Patient Education and Counseling, 46(4), 267–275. https://doi.org/10.1016/S0738-3991(01)00163-X.
Meropol, N. J., Daly, M. B., Vig, H. S., Manion, F. J., Manne, S. L., Mazar, C., …, Zubarev, V. (2011). Delivery of internet-based cancer genetic counselling services to patients’ homes: A feasibility study. Journal of Telemedicine and Telecare, 17(1), 36–40. https://doi.org/10.1258/jtt.2010.100116.
National Conference of State Legislators. (2015). Telehealth Policy Trends and Considerations. Retrieved June 24, 2017, from. http://www.ncsl.org/documents/health/telehealth2015.pdf.
National Society of Genetic Counselors. (2017). States Issuing Licenses for Genetic Counselors. Retrieved June 25, 2017, from http://www.nsgc.org/p/cm/ld/fid=19.
NSGC. (2016). 2016 Professional Status Survey: Work Setting Environment.
O’Malley, A. S., Samuel, D., Bond, A. M., & Carrier, E. (2012). After-hours care and its coordination with primary Care in the U.S. Journal of General Internal Medicine, 27(11), 1406–1415. https://doi.org/10.1007/s11606-012-2087-4.
Ormond, K. E., Haun, J., Cook, L., Duquette, D., Ludowese, C., & Matthews, A. L. (2000). Recommendations for telephone counseling. Journal of Genetic Counseling, 9(1), 63–71. https://doi.org/10.1023/A:1009433224504.
Otten, E., Birnie, E., Ranchor, A. V., & van Langen, I. M. (2016). Online genetic counseling from the providers’ perspective: Counselors’ evaluations and a time and cost analysis. European Journal of Human Genetics : EJHG, 24(9), 1255–1261. https://doi.org/10.1038/ejhg.2015.283.
Patton, M. Q. (2002). Qualitative evaluation and research methods. Research in Nursing & Health (3rd ed., Vol. 14). Thousand Oaks: SAGE Publications, Inc..
Peng, C. Y., Harwell, M. R., Liou, S. M., & Ehman, L. H. (2006). Real Data Analysis: Advances in missing data methods and implications for educational research S. S. Sawilowsky (Ed.), New York.
Rogers, A. E., Hwang, W.-T., Scott, L. D., Aiken, L. H., & Dinges, D. F. (2004). The working hours of hospital staff nurses and patient safety. Health Affairs, 23(4), 202–212. https://doi.org/10.1377/hlthaff.23.4.202.
Stimpfel, A. W., Sloane, D. M., & Aiken, L. H. (2012). The longer the shifts for hospital nurses, the higher the levels of burnout and patient dissatisfaction. Health Affairs, 31(11), 2501–2509. https://doi.org/10.1377/hlthaff.2011.1377.
Sutphen, R., Davila, B., Shappell, H., Holtje, T., Vadaparampil, S., Friedman, S., …, Armstrong, J. (2010). Real world experience with cancer genetic counseling via telephone. Familial Cancer, 9(4), 681–9. https://doi.org/10.1007/s10689-010-9369-y.
Wang, V. O. (2000). Commentary: What is and is not telephone counseling? Journal of Genetic Counseling, 9(1), 73–82. https://doi.org/10.1023/A:1009437308575.
Zierhut, H. A., Shannon, K. M., Cragun, D. L., & Cohen, S. A. (2016). Elucidating genetic counseling outcomes from the perspective of genetic counselors. Journal of Genetic Counseling, 25(5), 993–1001. https://doi.org/10.1007/s10897-015-9930-9.
Zilliacus, E., Meiser, B., Lobb, E., Barlow-Stewart, K., & Tucker, K. (2009). A balancing act--telehealth cancer genetics and practitioners’ experiences of a triadic consultation. Journal of Genetic Counseling, 18(6), 598–605. https://doi.org/10.1007/s10897-009-9247-7.
Zilliacus, E. M., Meiser, B., Lobb, E. A., Kirk, J., Warwick, L., & Tucker, K. (2010). Women’s experience of telehealth cancer genetic counseling. Journal of Genetic Counseling, 19(5), 463–472. https://doi.org/10.1007/s10897-010-9301-5.
Zilliacus, E. M., Meiser, B., Lobb, E. A., Kelly, P. J., Barlow-Stewart, K., Kirk, J. A., …, Tucker, K. M. (2011). Are videoconferenced consultations as effective as face-to-face consultations for hereditary breast and ovarian cancer genetic counseling?. Genetics in Medicine, 13(11), 933–941. https://doi.org/10.1097/GIM.0b013e3182217a19.
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This study was reviewed by the University of Minnesota Institution Review Board (#1610S97323).
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Jill Davies is the Co-Founder and Chief Operating Officer of GeneMatters, LLC an on-line genetic counseling company, and has equity in the company.
Heather Zierhut is a Senior Advisor to GeneMatters, LLC.
Zhara Ahmed declares that she has no conflict of interest.
Ian MacFarlane declares that he has no conflict of interest.
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All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was not obtained in the study.
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No animal studies were carried out by the authors for this article.
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Zierhut, H.A., MacFarlane, I.M., Ahmed, Z. et al. Genetic Counselors’ Experiences and Interest in Telegenetics and Remote Counseling. J Genet Counsel 27, 329–338 (2018). https://doi.org/10.1007/s10897-017-0200-x
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DOI: https://doi.org/10.1007/s10897-017-0200-x