Oncology Rounds

Is there an effective alternative to in-person genetic counseling?

Deirdre Fuller, Oncology Roundtable

Genetic counseling is an increasingly vital component of cancer care, but a lack of trained professionals and the cost of a genetic counselor pose challenges to offering it in-person. 

We've received a number of questions from members about the use of telephone-based genetic counseling. A recent article in JCO suggests that telephone-based counseling can serve as an effective and less costly alternative to in-person counseling.

Seeking alternatives to in-person genetic counseling

Access to genetic counseling is now required by many national accreditation organizations. The demand for counseling is likely to increase, since the USPSTF (U.S. Preventive Services Task Force) recently updated their guidelines to recommend genetic counseling referrals for all women with increased hereditary risk for the BRCA1/2 mutation. 

However, many cancer programs are struggling to meet the demand for in-person genetic counseling services due to the scarcity of genetic counselors and the high cost of hiring even a part-time genetic counselor. Many organizations are now exploring alternative ways to deliver genetic counseling.

Patients benefit from telephone-based genetic counseling

To test the option of telephone-based genetic counseling, researchers at the Lombardi Comprehensive Cancer Center at Georgetown University developed a randomized trial to test whether telephone delivery of BRCA1/2 genetic counseling is comparable to in-person services.

They found that knowledge, perceived stress, and satisfaction were similar between patients who received in-person and telephone counseling two weeks and three months after pre-test counseling. Decision conflict and cancer distress were also relatively unaffected. This shows that genetic counseling, whether delivered in person or by telephone, benefits patients during the BRCA1/2 testing process.

Slight decrease in patient testing following telephone counseling

The research did show that patients who received telephone counseling were less likely to take the BRCA1/2 test (84.2% uptake compared to 90.1% uptake for in-person counseling). 

This decrease is likely because patients receiving telephone-based counseling would have to travel to a clinic to provide the DNA sample, whereas patients receiving in-person counseling could immediately provide DNA following the session. This drop-off in testing is an important consideration, but could potentially be overcome by providing patients with at-home DNA sampling kits.

Lower cost to deliver telephone-based genetic counseling

Perhaps unsurprisingly, an advantage of telephone-based counseling was decreased costs—on average, it saved $114.40 per patient. Savings were generated from shorter counseling times, less patient travel, and lower overhead. Patients in rural areas who used in-home buccal DNA kits saved more than $321.

The potential to expand access

Telephone-based counseling can improve patient access to genetic counseling and testing, particularly for patients living in rural areas. But a huge impediment is the lack of reimbursement for telephone-based counseling. At present, the primary billing codes for genetic counseling are for in-person services only. 

While Aetna now provides coverage for telephone-based cancer genetic counseling, other payers have not followed suit. The authors of the Georgetown study hope that payers will increase coverage as more research demonstrates the effectiveness and cost-savings of telephone-based genetic counseling.

More on Genetic Counseling

To learn more about opportunities for telephone-based counseling, read our study chapter, "Telehealth: Genetics Counseling" from the Oncology System Strategy Playbook.