Benefit of over-the-phone vs face-to-face counselling for BRCA 1/2 genetic testing

The study investigated the suitability of using over-the-phone counselling as a method of educating women about BRCA1/2 testing.

In recent years many risk factors associated with developing hereditary (inherited) breast and ovarian cancers (HBOC) have been identified, for example the BRCA 1/2 genes. Identifying women at risk of developing HBOC is done through a genetic test. By identifying patients it is possible to improve treatment. However when genetic results come back, informing a woman she is isw positive for BRCA 1/2 and educating her on her options is a difficult duty.

It requires knowledge of medical care, HBOC and the genetic services such as counselling (patient is educated on the mutation, possibility of developing or passing it on, and their medical options). However less than 50% of patients receive genetic counselling.

Low counselling levels are related to numerous personal and logistic factors, and therefore a new approach of contacting patients and providing counselling is required. One such method is telehealth (counselling over the telephone) instead of the traditional in-person method. Importantly 98% of BRCA 1/2 test results are given by phone, however only 23% of genetic counsellors carry out pre-result counselling over the phone.

This study aimed to show telehealth was a suitable alternative to in-patient counselling. 

Of 1,200 patients, 988 were randomly assigned to two groups; those who received in-patient counselling (495) and those who received telehealth counselling (493). Telehealth patients received educational material about HBOC and were talked through it by their counsellor over the phone. Telehealth patients also received home genetic test kits. Patients receiving in-person counselling received the same material at their appointment and had the option to undergo immediate in-clinic testing.

Anxiety, distress about cancer, decisional conflict about BRCA1/2 testing, distress about undergoing testing, BRCA1/2 knowledge, mental and physical quality of life were all measured and compared between the two groups.

Follow up was performed at 1 week and 6 months post-testing. The study showed that telehealth counselling was not inferior to in-patient counselling in terms of dealing with patients anxiety, cancer-specific psychological distress, quality of life, knowledge, decisional conflict and decisional regret. However telehealth patients had a lower uptake of genetic testing (21.8%) than in-person counselling (31.8%).

Overall telehealth counselling was shown to be a safe alternative to in-patient counselling, though testing levels were lower in telehealth patients. 

Low testing levels associated with telehealth counselling could be associated with poor phone sales technique when compared to the in-patient counselling method.