ABSTRACT
Objectives: Our previously presented pilot study evaluated a web-based tool to collect family cancer history (FCH). It demonstrated that this tool resulted in significantly higher quality FCH compared to standard of care face-to-face physician interviews. However, the true value of FCH requires translation into the utilization of genetic services. Here, we aimed to evaluate referral rates and completion of genetic services for patients completing the web-based tool versus standard of care. Methods: Patients scheduled for a gynecologic oncology new patient visit between September 2019 and September 2021 were eligible for enrollment in this institutional review board-approved prospective trial. The trial had three arms: 1) Standard of care (FCH collection by physicians) 2) Web-based tool administered by email prior to the visit, 3) Web-based tool administered in the office prior to the visit (this arm closed early due to COVID-19 restrictions). Individuals were identified as high-risk for familial cancer if they met National Comprehensive Cancer Network (NCCN) guidelines in the standard of care arm, or if the validated cancer risk models embedded in the web-based tool returned a lifetime cancer risk >20% or mutation risk?>2.5% in the web-based tool arms. Validated risk assessment models included breast and ovarian BRCAPRO, Claus, Tyrer-Cuzick, Gail, colorectal and endometrial MMRPRO, MELAPRO, PANCPRO, and PREMM. The primary endpoint was the percentage of high-risk patients referred for genetic counseling/testing. Secondary endpoints included the completion of genetic counseling and genetic testing. Results: Two hundred and fifty patients were enrolled (Arm 1: 110;Arm 2: 105;Arm 3: 35). Among patients randomized to the web-based tool, 88 (63%) completed the tool. In the control arm, 31 patients (28%) met the criteria for referral to genetics, among which 18 (58%) had previously completed genetic testing. In the web-based tool arm, 26 patients (30%) met the criteria, among which 12 (46%) had previously completed genetic testing, and one was deceased soon after her visit. In the control arm, 54% of high-risk patients were referred to genetic counseling, 23% completed genetic counseling, and 23% completed genetic testing. In the web-based tool arm, 100% of high-risk patients were referred to genetic counseling, 54% completed genetic counseling, and 38% completed genetic testing (Table 1). Conclusions: When successfully completed, the use of a web-based tool for FCH collection facilitated the process of referral to genetics, resulting in significantly higher referral rates to genetic counseling than the standard of care physician interviews (100% vs 54%, p = 0.01). However, 37% of patients could not complete the web-based tool. Our findings demonstrate the potential power of health information technology to identify millions of individuals unknowingly carrying familial cancer syndromes and highlight those tools must be designed in a way to maximize patient participation.[Formula presented]
ABSTRACT
INTRODUCTION: The use of telemedicine has dramatically increased during the COVID-19 pandemic. We evaluated characteristics and experiences of underserved women utilizing telemedicine for gynecologic visits at an urban teaching hospital. METHODS: We conducted a prospective study of patients using telemedicine for gynecologic care from January 2021-September 2021. Patients completed a demographic survey and a modified Telemedicine Usability Questionnaire (TUQ) using a 1-5 Likert scale. Statistical analyses used Fisher's exact test. RESULTS: One hundred ninety two patients consented to participate, and 157 completed surveys. The majority of patients were non-White (Hispanic 32%, Black 28%, and Asian 10%), with a median age of 40 years (range 18-69 years). A total of 61% had children and some level of education (24% GED or below, 28% vocational/associate degree, and 47% college or above), and 41% were employed, with 63% reporting an income of less than $40,000, and 85% being government insured (Medicaid/Medicare). Without telemedicine visits, 47% would have traveled 1-2 hours to appointments, with 46% spending more than $35 on travel, and 27% missing at least 1 work day for an in-person visit. The most common visit indications were lab/imaging results review (37%), postoperative follow-up (21%), and abnormal uter- ine bleeding (14%). The mean score overall for the entire TUQ was 4.3/5. Participants preferred telemedicine for follow-up visits rather than for initial visits (81% vs. 33%;P<.01). CONCLUSION: Underserved women utilizing telemedicine for gynecologic care reported largely positive experiences with improved access to health care, cost, and time savings over inperson visits. However, a higher preference for utilization was found for follow-up visits, providing an opportunity to further improve quality and access.
ABSTRACT
INTRODUCTION: The use of telemedicine has dramatically increased during the COVID-19 pandemic. We evaluated the experience of underserved women using telemedicine for gynecologic visits at an urban teaching hospital. METHODS: We conducted a prospective study of patient experiences using telemedicine for outpatient gynecologic visits from January 2021-September 2021. Demographic/clinical data were obtained. Participants completed a modified, previously validated Telemedicine Usability Questionnaire (TUQ), with responses on a 1-5 Likert scale. Statistical analyses used the Wilcoxon signed-rank test or t test. RESULTS: One hundred ninety two patients agreed to participate, of which 157 completed the surveys. A total of 87% had video visits, whereas 13% had telephone visits. The majority of patients were ethnic minorities (non-Hispanic White 16%, Hispanic 32%, Black 28%, and Asian 10%), median age 40 years (range 18-69 years), with 63% having income (44 vs.<39, P=.02). Race/ethnicity, income, education level, and prior experience with telemedicine had no effect on responses for this subscale. CONCLUSION: Underserved women utilizing telemedicine for outpatient gynecologic visits report largely positive experiences overall. Although telemedicine holds promise in increasing access to healthcare services, attention needs to be paid to ensure reliability among telehealth visits, particularly for older populations.