Randomized noninferiority trial of telephone versus in-person genetic counseling for hereditary breast and ovarian cancer
| Autor: | Angie Tong, Wendy McKinnon, Rachel Nusbaum, Sarah A. Kelleher, Claudine Isaacs, Jeanne S. Mandelblatt, Shelley R. McCormick, Heiddis B. Valdimarsdottir, An Tsun Huang, Lesley King, George Luta, Patti Vegella, Marc Schwartz, Marie E. Wood, Judy Garber, Anita Y. Kinney, Kara Grace Leventhal, Kristi D. Graves, Beth N. Peshkin, Yaojen Chang |
|---|---|
| Rok vydání: | 2014 |
| Předmět: |
Adult
Cancer Research medicine.medical_specialty Health Knowledge Attitudes Practice Genetic counseling Cost-Benefit Analysis Decision Making Genes BRCA2 MEDLINE Genes BRCA1 Breast Neoplasms Genetic Counseling law.invention Conflict Psychological Patient satisfaction Quality of life Randomized controlled trial Telephone counseling law Medicine Humans Genetic Testing Genetic testing Aged Aged 80 and over Ovarian Neoplasms medicine.diagnostic_test business.industry Middle Aged Telephone Distress Oncology Patient Satisfaction Mutation Physical therapy Quality of Life Female business Stress Psychological |
| Zdroj: | Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 32(7) |
| ISSN: | 1527-7755 |
| Popis: | Purpose Although guidelines recommend in-person counseling before BRCA1/BRCA2 gene testing, genetic counseling is increasingly offered by telephone. As genomic testing becomes more common, evaluating alternative delivery approaches becomes increasingly salient. We tested whether telephone delivery of BRCA1/2 genetic counseling was noninferior to in-person delivery. Patients and Methods Participants (women age 21 to 85 years who did not have newly diagnosed or metastatic cancer and lived within a study site catchment area) were randomly assigned to usual care (UC; n = 334) or telephone counseling (TC; n = 335). UC participants received in-person pre- and post-test counseling; TC participants completed all counseling by telephone. Primary outcomes were knowledge, satisfaction, decision conflict, distress, and quality of life; secondary outcomes were equivalence of BRCA1/2 test uptake and costs of delivering TC versus UC. Results TC was noninferior to UC on all primary outcomes. At 2 weeks after pretest counseling, knowledge (d = 0.03; lower bound of 97.5% CI, −0.61), perceived stress (d = −0.12; upper bound of 97.5% CI, 0.21), and satisfaction (d = −0.16; lower bound of 97.5% CI, −0.70) had group differences and confidence intervals that did not cross their 1-point noninferiority limits. Decision conflict (d = 1.1; upper bound of 97.5% CI, 3.3) and cancer distress (d = −1.6; upper bound of 97.5% CI, 0.27) did not cross their 4-point noninferiority limit. Results were comparable at 3 months. TC was not equivalent to UC on BRCA1/2 test uptake (UC, 90.1%; TC, 84.2%). TC yielded cost savings of $114 per patient. Conclusion Genetic counseling can be effectively and efficiently delivered via telephone to increase access and decrease costs. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|