M44 - PATIENT OUTCOMES OF PSYCHIATRIC GENETIC COUNSELING: ASSESSING THE IMPACT OF DIFFERENT FAMILY HISTORY COLLECTION MODALITIES

Abstract

Background Though often thought of as an intervention exclusively concerned with delivering information about genetic testing/recurrence risk, Genetic Counseling (GC) is actually “a process of helping people to understand and adapt to the medical, psychological, and familial implications of genetic contributions to disease.” Documentation of family history (Fhx) is fundamental to this process for GC; it provides a basis for genetic risk assessment, and for personalizing conversations about illness etiology. The process of Fhx documentation can also build rapport, which is key to optimal patient outcomes of GC. Various approaches for obtaining the Fhx have been employed, often motivated by a desire to increase the efficiency of generating an accurate pedigree. However, no studies have evaluated whether different modalities for collection of Fhx data influence patient outcomes. Pre-appointment phone calls have the theoretical advantages of helping to clarify expectations and initiate rapport-building prior to the appointment, and allowing the patient and counselor to more fully attend to the content of the GC session if Fhx has been documented in advance. Methods We sought to test the hypothesis that patient outcomes of psychiatric GC would demonstrate more dramatic improvements when Fhx was collected via telephone prior to their appointment (FhxPrior) as compared to when Fhx was collected during the appointment (FhxDuring). We used data from our specialist psychiatric GC clinic, where as routine clinical practice, patients complete the GC outcomes scale (GCOS, measuring empowerment) and Illness Management Self Efficacy Scale (IMSES) immediately prior to GC (T1) and at one-month follow-up (T2). Because of the hypothetical advantages of collecting Fhx before the appointment, this is standard practice for the clinic. However, when a patient cannot be reached by telephone before the appointment, Fhx is collected during the appointment. Study inclusion criteria required: 1) that both T1 and T2 assessments were completed between 1 Feb 2012 - 31 Jan 2017, 2) that the Fhx was obtained from the patient him/herself, and 3) that the psychiatric GC appointment was conducted in person (rather than by telephone or videoconference). Change in scale scores between T1 and T2 were compared between groups using Mann-Whitney U tests. Results Of 573 patients who had completed T1 questionnaires, 240 met inclusion criteria and were included in the analysis (FhxPrior, n=206; FhxDuring, n=34). Overall, patient GCOS and IMSES scores increased significantly from T1-T2 (p=0.000, d=1.2 and p=0.004, d=0.24 respectively). The increase in IMSES scores from T1-T2 was significantly greater for the FhxPrior group than for the FhxDuring group (p=0.014, d=0.64). There was no difference in the increase in GCOS score between groups (p=0.649). Discussion Our data support previous findings regarding the important positive outcomes of psychiatric GC for patients, and suggest that obtaining Fhx via telephone prior to a psychiatric GC appointment may lead to greater increases in patient self-efficacy as compared to obtaining Fhx during the GC appointment. Future research will include prospective evaluation of alternate Fhx collection methods to maximize patient outcomes in our clinic.