Video-based genetic counseling to reduce physician workload and enhance consulter understanding: A prospective randomized clinical trial.

Abstract

1502 Background: Genetic counseling is an essential part of germline genetic testing, which is reccomended for use of PARP inhibitors in breast cancer treatment. Despite its importance, only about 40-60% of breast cancer patients receive genetic counseling. A video tool has been developed to provide genetic counseling, aiming to reduce the physician's workload and improve the patient's understanding. Methods: Advice seekers at increased risk for hereditary breast and ovarian cancer as well as breast and ovarian cancer patients were included in the trial. They were randomly assigned 1:1 to either standard of care (physician only, PO) or video based followed by physician genetic counseling (VPO). A 15-minute video tool was created for VPO participants, who watched it on an iPad and answered 6 comprehension questions online. The physician then clarified any misunderstood topics. In both groups, counseling time was measured from conversation start to blood donation. Afterwards, participants completed a questionnaire with 9 comprehension questions (16 points total). Data analysis included Bernard’s and Pearson’s tests for categorical data, Kendall’s test for correlations, and ordinal logistic regression for multivariable analysis. Results: A total of 110 participants with a median age of 47 years were randomized into two groups: PO counseling (55 participants, 50%) and VPO counseling (55 participants, 50%). Among them, 29% (32 participants) received therapeutic counseling for breast/ovarian cancer, while 71% (78 participants) received predictive counseling with no cancer diagnosis. Participant characteristics were well balanced between groups, with no significant differences in age, indication for counseling, sex (90% female), level of education, or German-speaking proficiency. Participants reported their sources of genetics knowledge as previous knowledge (30%) and physician counseling (70%) in the PO group, and as previous knowledge (20%), physician counseling (30%), and the video tool (45%) in the VPO group. The video significantly improved comprehension scores from 62.5% (10 points, PO group) to 81.3% (13 points,VPO group) (p < 0.0001). Additionally, the video tool significantly reduced the time physicians spent on counseling from 6.6 minutes to 2.4 minutes (p < 0.0001). According to the logistic regression model, both the level of education (estimate -1.34, p = 0.002) and German language comprehension level (estimate 1.62, p = 0.001) significantly influenced the genetic counseling comprehension score. Conclusions: In this prospective randomized trial, video genetic counseling improved comprehension and reduced physician counseling time. The genetic video tool, which can be translated into various languages, facilitates genetic counseling by decreasing the workload for physicians, which may increase the genetic counseling rate in the clinic.