Jacobs Aryana S, Schwartz Marc D, Valdimarsdottir Heiddis, Nusbaum Rachel H, Hooker Gillian W, DeMarco Tiffani A, Heinzmann Jessica E, McKinnon Wendy, McCormick Shelley R, Davis Claire, Forman Andrea D, Lebensohn Alexandra Perez, Dalton Emily, Tully Diana Moglia, Graves Kristi D, Similuk Morgan, Kelly Scott, Peshkin Beth N
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.
Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Fam Cancer. 2016 Oct;15(4):529-39. doi: 10.1007/s10689-016-9900-x.
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.
对于有兴趣进行BRCA1/2检测的高危女性，电话遗传咨询（TC）已被证明能产生与常规护理（UC；面对面）遗传咨询相当的积极结果。然而，对于遗传咨询师如何看待这些替代形式的遗传咨询的提供情况，人们知之甚少。作为TC与UC的随机试验的一部分，遗传咨询师完成了一份包含5个项目的遗传咨询师过程问卷（GCQ），该问卷评估了479名女性参与者（TC组，N = 236；UC组，N = 243）检测前咨询环节的关键要素（信息传递、情感支持、解答疑问和担忧、咨询环节的个性化定制以及决策促进）。TC组和UC组咨询环节的GCQ得分没有差异（t(477) = 0.11，p = 0.910）。然而，多变量分析表明，参与者的种族/民族显著预测了遗传咨询师的看法（β = 0.172，p < 0.001），即TC组和UC组中少数族裔的GCQ得分较低。探索性分析表明，GCQ得分可能与患者对UC和TC的偏好有关（t(79) = 2.21，p = 0.030）。此外，我们发现遗传咨询师对咨询环节有效性的评分通常与患者对该环节的看法一致。这些数据表明，遗传咨询师认为TC的关键组成部分可以与UC一样有效地提供，并且这些要素可能有助于提高患者满意度的特定方面。然而，可能存在未明确的过程差异，这导致咨询师对与少数族裔女性（即非西班牙裔白人以外的女性）咨询环节有效性的看法较低。我们讨论了研究结果的其他潜在临床和研究意义。
