SLIDE 1
- This work was partially funded by the
Examination of the Impact of Cancer Telegenetics among a Rural - - PowerPoint PPT Presentation
Examination of the Impact of Cancer Telegenetics among a Rural - - PowerPoint PPT Presentation
Examination of the Impact of Cancer Telegenetics among a Rural Patient Population: Comparison with Traditional InPerson Services NNECOS Annual Meeting 2016 Susan Miesfeldt, MD Maine Medical Center This work was partially funded by the
SLIDE 2
SLIDE 3
Background
- New models of telecommunication, including two‐
way videoconferencing (telehealth), promise to address growing demands for cancer genetic counseling services
- Little is known about the impact of cancer
telegenetics among the geographically underserved
- Improved awareness of the patient‐focused
- utcome of telegenetics is essential to scaling this
model nationally
- An understanding of patients’ attitudes regarding
satisfaction with/acceptability of this technology is critical to widespread adoption and sustainability
SLIDE 4
Goals
- To examine clinical outcome and
attitudes/beliefs regarding cancer telegenetic services in Maine
- To compare clinical outcome among
telegenetics versus traditional in‐person patients
SLIDE 5
Current cancer genetic services in Maine
- Gaps in access to high quality cancer genetic services in Maine are
apparent, particularly for those from rurally remote regions of the state
- ^MMC‐staffed telegenetic services provided in Augusta (MaineGeneral) and
Belfast (Waldo County General Hospital)
- All sites serve rural patients
Maine Cancer Genetic Services
Maine Medical Center (MMC)^
Medical oncologist & cancer genetic counselor
New England Cancer Specialists*
Cancer genetic counselor
* serves NECS patients
Central Maine Medical Center
Contracted genetic counselor
Eastern Maine Medical Center
Geneticist and contracted counselor
^ ^
SLIDE 6
Methods
- Pre‐/post‐survey (immediate and 1‐month)
administered to cancer telegenetics patients seen at two remote sites and control patients seen in‐person
- Survey developed by study team using items
from existing, validated instruments plus items developed based on study goals
- It assessed:
–Care impact on hereditary cancer knowledge and emotional status –Ease of access to services –Satisfaction with/acceptability of telegenetics
SLIDE 7
Results
- Participants
–A total of 174 responded to one or more surveys (106 remote; 68 control) –158 (90%) returned pre‐ and immediate post‐ counseling surveys (90 remote; 68 control) –One‐month post‐counseling surveys were returned by 41/90 remote patients (46%) and 24/68 in‐person patients (35%) –Response to individual survey items varied
SLIDE 8
Sociodemographic characteristics
Characteristic Remote n=106 In‐person n=68 Comparison p‐value Age in years (mean; SD) 55 (15.1) 49 (13.5) 0.02 Women (%) 83 84 0.55 Education level high school or less (n;%) 28 (26%) 6 (9%) 0.006 Rural county of residence (n;%) 95 (90%) 27 (40%) <0.0001 Cancer history 60 (57%) 29 (43%) 0.005
No difference in groups relative to race, ethnicity, perceived health insurance status or family history of cancer
SLIDE 9
Clinical Outcome: Group Comparisons
Variable Remote Pre Mean (SD) Remote Post Mean (SD) In‐person Pre Mean (SD) In‐person Post Mean (SD) Change difference p‐value Breast ca knowledge
3.7 (2.25) 6.6*(1.54) 4.1 (2.18) 6.9*(1.63) 0.85
Colon ca knowledge
1.3 (0.98) 2.3*(0.86) 1.5 (0.94) 2.4*(0.71) 0.43
Anxiety
1.4 (1.84) 1.2⌃(1.54) 1.0 (1.25) 0.8*(1.14) 0.59
Depression
0.90(1.53) 0.67*(1.31) 0.42(0.96) 0.35 (0.84) 0.09
*signifies statically significant change, pre‐ versus immediately post‐counseling ⌃signifies borderline significance, pre‐ versus immediately post‐counseling Breast cancer knowledge measure = mean number of correct responses out of 9 Colorectal cancer knowledge measure = mean number of correct responses out of 4 Anxiety and Depression items depict mean measure level (sum of 2 items, 0‐3 scale; low to high symptom burden)
SLIDE 10
Clinical Impact 1‐month Post‐Counseling
- Lower 1‐month response rate limited
comparison with pre‐ and immediate post‐ counseling data
–There was decline in colon cancer knowledge among both groups one month following counseling versus immediately post‐counseling –Anxiety and depression measures were lower in both groups at one month; comparing groups, measures remained higher in remote cohort
SLIDE 11
Impact of Telegenetics on Care Access
13% 25% 12% 5% 81% 32% 24% 9%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Travel 50+ miles Miss work Someone else miss work Childcare Telegenetic services No telegenetic services *Participant response to individual survey items varied.
n = 102
SLIDE 12
Satisfaction with Technology
100% 97% 97% 97% 99% 90% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
The process of talking was clear (n=89) Did not need help using the system (n=89) The computer picture was clear (n=90) I could hear the providers clearly (n=90) I trusted the conversation was confidential (n=89) If the computer stopped working I got help (n=39)
Remote patients only, immediately post‐counseling
SLIDE 13
Acceptability of Telegenetic Services
87% 95% 32% 98% 100% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Telemedicine took care of my needs (n=40) Better access to genetic services with telemedicine (n=41) Prefer to see a provider in person (n=40) Use telemedicine again (n=41) Overall happy with service (n=41)
Remote participants only; 1 month post‐counseling (n=41)
SLIDE 14
Conclusions
- There were few differences in clinical
- utcome comparing traditional in‐person
services with telegenetic services
- The availability of telegenetics eased
transportation needs and work absences
- Despite occasional technical problems
(equipment and internet access) remote study participants were satisfied with the quality of the technology used
SLIDE 15
Conclusions II
- Although there was overall acceptance of
telegenetics, nearly a third of remote patients noted preference for in‐person care
- These data relate directly to the scalability of
telegenetics as a means to extend access to cancer genetic counseling among those from geographically underserved areas regionally and nationally
SLIDE 16