Masters Thesis

Evaluation of the genetic testing station, an alternative video-based model of cancer genetic counseling and testing

The UCSF Cancer Genetics and Prevention Program (CGPP) has implemented an alternative service delivery model to provide rapid genetic services to a growing number of patients with breast cancer. Dubbed the Genetic Testing Station (GTS), this Genetic Counseling Assistant (GCA) facilitated model gives patients treated at UCSF access to a same-day genetic testing appointment utilizing video genetics education designed by the CGPP. As a first step in evaluating the effectiveness of this model, this study examined patient decision making and genetic counseling satisfaction. Participants seen at UCSF for a new diagnosis of breast cancer were sent to the GTS for genetic testing at clinician discretion. After viewing educational videos and providing informed consent, GCAs administered the SURE decisional conflict scale (DC), a validated measure of assuredness of their decision to proceed with genetic testing. Following completion of genetic testing and results disclosure with a genetic counselor, participants were contacted by phone and/or email to complete the Genetic Counseling Satisfaction Scale (GCSS). Binary and Likert scale responses were scored for the GTS cohort. As a comparison group, individuals with a diagnosis of breast cancer receiving traditional pre- and post-test genetic counseling (traditional model) were also administered DC at the time of informed consent, and GCSS after results disclosure. Mean DC for the GTS group was 3.83 (out of a possible 4.0), and there was no significant difference in scores between the GTS and traditional model (p = 0.845). Mean GCSS of the GTS patients was 5.38 (out of a possible 6.0) and GCSS scores between the models were not significantly different (p = 0.363). This study demonstrates that GTS patients have a low level of uncertainty about their decision to undergo genetic testing, are provided enough information and support for decision making, and are ultimately satisfied with the process of genetic testing and counseling. In addition, this study supports the hypothesis that the GTS model does not decrease satisfaction with genetic counseling services when compared to the traditional model. By leveraging video-based education and GCAs, the GTS is a feasible model to increase access to genetic testing that facilitates appropriate decision making and satisfaction with genetic counseling.