Dr Banu Arun on Technologies to Expand Access to Genetic Counseling

There are new technologies that allow for genetic counseling services through which the provider does not even need to get that involved in the process, said Banu Arun, MD, medical oncologist, Department of Breast Medical Oncology, Division of Cancer Medicine, MD Anderson Cancer Center.

Can you discuss the role of technology in expanding genetic counseling among patients with or at risk of developing breast cancer?
So, patients, let's start with patients with breast cancer. So, for patients with breast cancer, I think the question is, you know, what technologies we can use to do the genetic counseling. You know, you can do the traditional face-to-face counseling with the genetic counselor and the patient—that takes anywhere between 20 to 40 minutes—where pretest counseling is done and then you can order the test and you do the posttest counseling. So, that is what is widely used and what we've been doing.

But because of the increased number of patients, and the broadening testing guidelines, this might not work in especially high-volume clinics. So, what technology can use? For example, something we implemented, and I gave an example in my talk [at the San Antonio Breast Cancer Symposium], and in a heavy clinic, is to do education by video, where the patient watches, you know, a preprepared video about genetics, family history, you know, indications for testing, [and] potential results for 10 to 15 minutes. And then the provider orders the test. And when the test results are positive, either pathogenic mutation or a VUS [variant of uncertain significance], then the patient is referred for genetic counseling and is meeting with the genetic counselor. So, that's how you combine the technology with face-to-face counseling.

Now another way could be where the provider, and the counselor, is not involved at all. For example, doing web-based counseling. It is a one-way communication where the patient watches a video or a web-based presentation, and then a testing kit is sent home. The patient spits in it and then it's sent for it for genetic testing. So, there is no provider involvement. And some other technologies where a provider is not involved could include the chatbots and using some AI [artificial intelligence] technologies, but they're very new, and there are not too many studies about the outcome. But we, and other groups, are already doing some studies with using these technologies.
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