Telemedicine vs in-person cancer genetic counseling: measuring satisfaction and conducting economic analysis

Santanu K Datta^1,2, Adam H Buchanan³, Gail P Hollowell⁴, Henry F Beresford⁵, Paul K Marcom^1,3, Martha B Adams^1,6
1Department of Medicine, Duke University; ²Center for Health Services Research in Primary Care, Durham VA Medical Center; ³Duke Cancer Institute, Duke University; ⁴Department of Biology, North Carolina Central University; ⁵School of Nursing, Duke University; ⁶Department of Community and Family Medicine, Duke University, Durham, NC, USA

Abstract: Cancer genetic counseling (CGC) provides benefits and is the standard of care for individuals at increased risk of having a hereditary cancer syndrome. CGC services are typically centered in urban medical centers, leading to limited access to counseling in rural communities. Telemedicine has the potential to improve access to CGC, increase efficient use of genetic counselors, and improve patient care in rural communities. For telemedicine CGC to gain wide acceptance and implementation it needs to be shown that individuals who receive telemedicine CGC have high satisfaction levels and that CGC is cost-effective; however little research has been conducted to measure the impact of telemedicine CGC. This paper describes the design and methodology of a randomized controlled trial comparing telemedicine with in-person CGC. Measurement of patient satisfaction and effectiveness outcomes are described, as is measurement of costs that are included in an economic analysis. Study design and methodologies used are presented as a contribution to future comparative effectiveness investigations in the telemedicine genetic counseling field.

Keywords: cancer genetics, genetic counseling, rural health services, telemedicine, satisfaction, cost