Background
Childhood cancer survivors and genetic testing
Remote telehealth genetic services
The in-home, collaborative PCP model for remote genetic services
Present study
Objectives
Specific aim 1
Specific aim 2
Specific aim 3
Methods
Study design
Setting
Study participants
Eligibility
Recruitment
Enrollment goals
Characteristic | N | % |
---|---|---|
Current age Median (range) | 39.0 (18.0–67.0) | |
Years from dx Median (range) | 32.0 (17.0–47.0) | |
Male Gender | 3758 | 51.7 |
Race/Ethnicity | ||
White | 6133 | 84.4 |
Black | 437 | 6.0 |
Other/Mixed race | 591 | 8.2 |
Hispanic | 642 | 9.1 |
Graduated College | 3320 | 46.0 |
Insured | 6299 | 87.2 |
Primary cancer diagnosis | ||
Osteosarcoma | 1175 | 11.7 |
Soft-tissue sarcoma | 852 | 16.2 |
History of an SMN | 169 | 2.3 |
Family history | ||
FDR with ovary, male breast, or pancreatic cancer | 181 | 2.5 |
Family history of breast, colon, or uterine cancer | 964 | 13.1 |
Study arms
ARM A: Remote telegenetic services by videoconference
ARM B: Remote telegenetic services by phone
ARM C: Usual care
Genetic testing
Genetic testing and PCP collaboration (Arms A and B)
Outcomes
Conceptual model (Fig. 5)
Effectiveness outcomes (Aim 1)
Effectiveness outcomes (Aim 2)
CONSTRUCT | T0 | T1 | T2-T4 |
---|---|---|---|
Moderators of patient outcomes
| |||
Sociodemographics | X | ||
Cancer history | X | ||
Family history | X | ||
Health literacy | X | ||
Comfort with technology | X | ||
Self-efficacy | X | ||
COVID Impact | X | X | |
Outcomes
| |||
Uptake counsling, testing, identification carriers at 6 months
a (Telegenetics records for Arms A/B & the 6-Month Status Survey in Arm C)
| |||
Understanding of Genetic Information
b
| |||
Test result recall | X | ||
Knowledge of genetic disease | X | X | X |
Perceived risk | X | X | X |
Reactions to genetic information
b
| |||
Anxiety and Depression | X | X | X |
Cancer specific distress | X | X | X |
Satisfaction with genetic services and telemedicine | X | X | |
Behavioral use of genetic information
b
| |||
Performance of behaviors | X | X | |
Cost (patient and system)b
| X | X |
Implementation outcomes
Measures | Sample Items | PCP Reg | Patient Survey | TG service records | Key Informant Interviewsa |
---|---|---|---|---|---|
Intervention Characteristics
| |||||
Relative advantage | Perception that remote services provides an advantage over existing care options | X | X | ||
Adaptability | Perception that the intervention could be modified to meet practice, provider or patient needs, recommendations for improvement | X | X | ||
Complexity | Perception that services were too complex | X | X | X | |
Cost | Perception that remote services genetic counseling or testing would be too costly for patient, practice (cost or resources) | X | X | X | |
Outer setting
| |||||
Provider needs and resources | Awareness of genetic risk and cancer prevention; importance within practice | X | |||
Provider incentives and disincentives | External mandates for genetic testing (e.g. accreditation) | X | |||
Inner Setting
| |||||
Structural characteristics | EMR, medical staff #, structure | X | X | ||
Climate for implementation | Previous innovation implementation, compatibility with practice, relative priority, quality metrics/rewards | X | |||
Readiness for Implementation | Available staff resources, practice experience with genetic services | X | X | ||
Characteristics of Individuals
| |||||
Practice background | Type of practice, practice setting | X | |||
Provider practice characteristics | Years in practice, gender, comfort with genetic testing, champion for genetic testing | X | |||
Patient background | Age, race, ethnicity, education, insurance | X | |||
Patient attitude toward genetic testing | Attitudes about genetic testing scale (8 items)3
| X | |||
Patient preference for shared medical decision making | Control Preference Scale (5 items)4
| X | |||
Patient comfort with technology | HINTS 5, Cycle 1 selected items related to internet and social media use (8 items) and electronic medical record use and perceptions of privacy (14 items)5
| X | |||
Patients baseline genetic knowledge, health literacy and affect | See Table 2 and corresponding measures in Section C6. Effectiveness outcomes | X | |||
Process
| |||||
Planning | Planning process for PCPs, quality of materials to introduce the program, steps for PCPs/practice and supports provided | – | Xb
| X | |
Opinion leaders | Who in the practice was most influential, how did they influence others or what could have helped them to be more effective | X | |||
Champions | Who in the practice helped ensure that all steps were completed? What did they do to make the practice successful? | X | X | ||
Reflecting and evaluation | What procedures are working? Which are not? What can we change to make the process easier? etc | Xc
| Xc
|
Data analysis plan
Primary effectiveness analysis: remote telegenetic services compared to usual care (Aim 1)
Sample size justification for aim 1
Secondary effectiveness analysis: remote videoconference compared to phone services (Aim 2a)
Sample size justification for aim 2a
Variable | Change scoresa (SD) of phone vs. videoconferencing | Number neededb
|
---|---|---|
Knowledge | + 5.7 (11.2) vs. + 18.6 (12.6) | 22/arm |
Cancer specific distressc
| + 3.6 (12.4) v. -2.6 (12.3) | 95/arm |
Depression | -0.2 (2.0) vs. -1.6 (2.0) | 50/arm |