Alex Husband

Video Education Is an Acceptable Alternative to Pretest Genetic Counseling for Patients With Breast, Ovarian, Pancreatic, and Metastatic Prostate Cancer: Results From a Randomized Study

PURPOSE With increased demand for cancer genetic testing (GT), providers are exploring alternative service delivery models such as video education (VE). We compare the uptake of GT among 250 patients with breast, ovarian, pancreatic, or metastatic prostate cancer randomly assigned to receive either pretest VE or a pretest visit with a genetic counselor (GC). MATERIALS AND METHODS Using a 3:1 ratio, 187 patients were randomly assigned to the VE arm and 63 patients to the GC arm. GT was arranged after participants either watched an informative video (VE arm) or met with a GC (GC arm). Satisfaction, knowledge, distress, decisional regret, and family communication were assessed as secondary study end points. RESULTS Participants were age 39-88 years with no significant demographic differences between the two arms. In the VE arm, 170 (90.95%) participants completed GT versus 49 (77.8%) in the GC arm ( P = .01). The dropout rate before the pretest visit was higher in the GC arm compared with the VE arm: 10 (15.9%) versus 9 (4.8%). In the GC arm, 97.4% of participants felt all questions and concerns had been addressed compared with 66.9% of the VE arm ( P < .0001). Of the 219 participants tested, 29 (13.2%) had a pathogenic or likely pathogenic variant. CONCLUSION In this study, there was high acceptance of VE and it led to better GT uptake compared with the GC arm. However, it will be important for programs using VE to build-in more opportunities for patients to ask questions. Pretest VE is a viable option for patients with cancer who need their germline genetic test results to help guide surgical and medical decisions.

Changes in Risk Tolerance for Ovarian Cancer Prevention Strategies during the COVID-19 Pandemic: Results of a Discrete Choice Experiment

Background Prior to COVID-19, little was known about how risks associated with such a pandemic would compete with and influence patient decision making regarding cancer risk reducing medical decision making. We investigated how the pandemic affected preferences for medical risk-reducing strategies among women at elevated risk of breast or ovarian cancer. Methods We conducted a discrete choice experiment. Women about to undergo genetic testing and counseling at 2 medical centers participated. Enrollment occurred between 2019 and 2022, allowing us to investigate changes in preferences from before the pandemic to after the pandemic. Women chose from permuted scenarios that specified type of surgery, age of menopause, quality of menopausal symptoms, and risk of ovarian cancer, heart disease, or osteoporosis. Results A total of 355 women, with a median age of 36 y, participated. In 2019, women were less likely to choose prevention scenarios with higher ovarian cancer risk (odds ratio [OR] = 0.42 per 10-point increase in risk, 95% confidence interval [CI] 0.22–0.61). In June 2020, the effect of higher ovarian cancer risk scenarios on choice was attenuated (OR = 0.86, 95% CI 0.68–1.04), with the effect becoming more salient again by July 2021 (OR = 0.59, 95% CI 0.52–0.67) ( P = 0.039 for test of temporal interaction). No other attribute demonstrated a temporal trend. Conclusion The risks associated with the COVID-19 pandemic may have attenuated the impact of risk of ovarian cancer on choice of risk-reducing prevention strategies for ovarian cancer. The maximum attenuation occurred at the beginning of the pandemic when access to risk-reducing surgery was most restricted. Our findings highlight how individuals evaluate competing health risks and adjust their uptake of cancer prevention strategies when faced with a future pandemic or similar global crisis. Highlights In this discrete choice experiment, women were much less likely to choose prevention scenarios that had higher ovarian cancer risk prior to the COVID-19 pandemic than after the pandemic. The attenuation of preferences may have persisted through 2022. COVID-19 may have altered the relative importance of factors that motivate women to undergo risk-reducing surgeries.