Alternative Service Delivery Models Research Articles

Feasibility Testing of Digitise Home Visit Service(DHVS) Core Model

The COVID-19 pandemic precipitated a global surge in homeschooling (Ray et al., 2020). While support networks for homeschooling parents have expanded, access to in-home educational professionals, particularly in rural areas, remains a significant challenge (Bullock & Davis, 2018). This study introduces a novel "Digitized Home Visit Education Services (DHVS) (Sathya D H, 2024)" model to address this gap. Building on two years of experience delivering one- to-one home visit special education, our model integrates online monitoring with in-home support from a local trained resource person. The model's feasibility was assessed through a comprehensive evaluation, encompassing subject selection, learning profile analysis, teacher training, and online monitoring during home visits. Semi-structured interviews with the parent, the teacher, the trained resource person, and the passive observer provide qualitative data to refine the model. This paper delves into the Digitised Home Visit Service (DHVS) Core Model, evaluating its feasibility and acceptability. Findings will contribute to the development of DHVS as an alternative special education and therapy service delivery model (Sathya D H, 2024), informing rehabilitation and special education professionals about an innovative method leveraging technology to reach needy students. Parents of students with disabilities will appreciate the digitised home visit model when it becomes available for their children to receive education at home.

A Systematic Review of Alternative Service Delivery in Africa for Taming Wicked Risks

This research considers the role that alternative service delivery can play in addressing wicked problems. The aim of this research is, firstly, to determine which evidence and knowledge are available on alternative service delivery arrangements relevant to African countries to inform decisions about addressing wicked problems on the continent. Second, this research determines suitable mechanisms for an alternative service delivery model for mitigating wicked risks in Africa. This research is based on a systematic literature review. This systematic literature review reveals that most work on alternative service delivery has been done in developed countries, with developing African countries being left behind in research on alternative service delivery. Furthermore, most of the alternative service delivery efforts have not focused on addressing wicked problems. A large number of articles on alternative service delivery models show that alternative delivery is not a preferred approach in Africa. This research recommends an alternative service delivery model that is based on digital governance, service delivery innovation and partnerships. Robust governance responses are needed to mitigate these wicked risks, and alternative service delivery presents robust features to mitigate these risks given that it is more flexible, agile, adaptable, and decentralized in nature than simply relying on traditional government responses. Lastly, risk-informed decision-making should be placed at the center of the reform agenda for a smart and sustainable society.

Errors in genome sequencing result disclosures: A randomized controlled trial comparing neonatology non-genetics healthcare professionals and genetic counselors

PurposeWe compared the rate of errors in genome sequencing (GS) result disclosures by genetic counselors (GC) and trained non-genetics healthcare professionals (NGHPs) in SouthSeq, a randomized trial utilizing GS in critically ill infants. MethodsOver 400 recorded GS result disclosures were analyzed for major and minor errors. We used Fisher’s exact test to compare error rates between GCs and NGHPs and performed a qualitative content analysis to characterize error themes. ResultsMajor errors were identified in 7.5% of disclosures by NGHPs and in no disclosures by GCs. Minor errors were identified in 32.1% of disclosures by NGHPs and in 11.4% of disclosures by GCs. Although most disclosures lacked errors, NGHPs were significantly more likely to make any error than GCs for all result types (positive, negative, or uncertain). Common major error themes include omission of critical information, overstating a negative result, and overinterpreting an uncertain result. The most common minor error was failing to disclose negative secondary findings. ConclusionTrained NGHPs made clinically significant errors in GS result disclosures. Characterizing common errors in result disclosure can illuminate gaps in education to inform the development of future genomics training and alternative service delivery models.

"Close to My Community": A Qualitative Study of Community Health Worker-Supported Teleaudiology Hearing Aid Services.

Given well-documented disparities in rural and minority communities, alternative service delivery models that help improve access to hearing care are needed. This article reports on a study of older Latino adults with hearing loss who received hearing aid services with Community Health Workers (CHWs) providing support via teleaudiology. The present study used qualitative data to explore perceptions of this novel service delivery model. Participants completed semistructured interviews related to their experiences in the intervention approximately 17 weeks after the hearing aid fitting appointment. Two coders independently coded the data, using an iterative deductive and inductive thematic analysis approach. Inter-rater reliability was good (κ = 0.80). Of the 28 participants, 19 were interviewed (CHW group: n = 9, 8 females; non-CHW group: n = 10, 9 females). Both groups of participants reported experiencing barriers in access to care and reported positive experiences with teleaudiology and with hearing aids as part of the trial. CHW group participants reported interactions with patient-site facilitators that were indicative of patient-centeredness. Results demonstrate the feasibility and potential effectiveness of trained CHWs as patient-site facilitators in teleaudiology-delivered hearing aid services for adults.

Access to and Utilization of Maternal and Child Healthcare Services During COVID-19 Pandemic in Rural Bangladesh.

Geographically remote areas in lower-middle-income countries like Bangladesh experienced significant Maternal and Child Health (MCH) care shortages during the COVID-19 pandemic. These shortages were exacerbated by preexisting inadequate public health infrastructure and using existing health resources for pandemic management. The objective of this study was to assess the status of access to and utilization of maternal and child healthcare services among rural people during the outbreak of COVID-19. A community-based descriptive, exploratory, cross-sectional study was carried out from May to August 2020 among the rural people of the four districts of northern Bangladesh. A total of 639 women were included in the study with a sample random sampling technique, and multistage random sampling techniques were applied to select the study area. A pretested semi-structured questionnaire was used for data collection. SPSS Version 22 was used for the statistical analysis. The mean age of the respondents was 34.3 years with an SD ± 10 years. 37.7% of respondents belonged to the 21-30 year age group followed by the 31-40 years age group (34.9 %). Of the total 639 respondents, 59.5% were female. There were significant associations and moderate positive correlations between educational qualification, occupational status, and age group of the respondents (p=0.001). Most of the respondents (67.6%) indicated that they experienced health problems during COVID-19 with 70.6% of them specifically mentioning MCH-related problems. Out of them, only 33.1% mentioned they could access and utilize MCH services, whereas 66.9% of them could not access MCH Services. Major barriers to utilizing MCH services were the COVID-19 lockdown, lack of transport facilities, fear of being infected, shutdown of healthcare facilities, and unavailability of healthcare professionals. The differences in health facility usage before and during COVID-19 are statistically significant with p = < 0.001. During the COVID-19 pandemic, access to and utilization of MCH services was significantly hampered, particularly in Bangladesh's remote and rural regions during the strict lockdown times. The identified barriers were the COVID-19 lockdown, lack of transport facilities, fear of being infected, shutdown of healthcare facilities, and unavailability of healthcare professionals. Building strengthened health systems, capacity building of informal healthcare providers, backup plans, and alternate service delivery models are necessary to ensure access to maternity and child health. For future pandemics and natural disaster situations, the 'concerned officials should strategically have backup plans and alternative service delivery models to strengthen the health system. And, there should be collaborative efforts among the countries to support each other to address the crisis situations.

Effectiveness of Mirror Therapy through Telerehabilitation on Upper Extremity Performance in Hemiparetic Stroke Patients: An Experimental Study

Introduction: A major challenge in stroke rehabilitation is the paresis of the Upper Extremity (UE), resulting in limited functional performance. Recently, motor imagery and Mirror Therapy (MT) have been recommended as an additional rehabilitation strategies that could be beneficial for motor rehabilitation after a stroke. Aim: To determine the effectiveness of mirror visual feedback through Telerehabilitation (TR) on UE functional performance in hemiparetic stroke patients. Materials and Methods: An experimental pretest, post-test study design was conducted at SRM Medical College Hospital and Research Centre, SRMIST, Kattankulathur, Chengalpattu, Tamil Nadu, India from January 2021 to June 2021. Total of 60 patients diagnosed with hemiparetic stroke were included in the study through convenience sampling and divided into two groups. The experimental group (n=30) received TR, and the control group (n=30) received face-to-face MT for 12 weeks. A pretest and post-test evaluation were administered using the Wolf Motor Function Test (WMFT) and Fugl-Meyer Assessment for the Upper Extremity (FMA-UE). Within-group analysis was performed using the Wilcoxon Signed-Rank Test, while intergroup analysis was conducted using the Mann-Whitney U Test. Results: The study revealed statistical significance between the pretest and post-test scores of the WMFT-FAS (Functional Ability Score), WMFT-Time (Performance Time), and FMA-UE in the control and experimental groups. The results showed no statistically significant difference between the post-test scores of the control and experimental groups in the FMA and WMFTFAS. However, there was a statistically significant distinction in the post-test scores between the control and experimental groups in WMFT-Time. Conclusion: The study concluded that mirror visual feedback through TR was an effective treatment method to improve UE functional performance among hemiparetic stroke patients by offering an alternative service delivery model for occupational therapy

Abortion Clients’ Perceptions of Alternative Medication Abortion Service Delivery Options in Mississippi

ObjectivesWe assessed Mississippi abortion clients’ perceptions of alternative medication abortion service delivery options that were restricted under state law but available elsewhere. MethodsWe conducted in-depth interviews with medication abortion clients between November 2020 and March 2021 at Mississippi's only abortion facility. We described alternative service delivery models: telemedicine, medications by mail, and follow-up care in their community versus returning to the facility. We asked if participants would be interested in using any of these models, if available, and how use of each model would have changed their abortion experience. We used thematic analysis, organizing codes into common themes based on participants' preferences and concerns for each option. ResultsOf the 25 participants interviewed, nearly all (n = 22) expressed interest in at least one option and reported that, had they been available, these would have alleviated cost, travel, and childcare barriers. Many believed these options would further ensure privacy, but a minority thought abortion was too sensitive for telemedicine or were concerned about mailing errors. Participants not interested in the alternative options also feared missing valued aspects of face-to-face care. Most did not return to the facility for follow-up (n = 19), citing financial and logistical barriers. Largely, participants were not interested in obtaining follow-up care in their community, citing concerns about provider judgment, stigma, and privacy. ConclusionsMississippi abortion clients were interested in models that would make abortion care more convenient while ensuring their privacy and allowing for meaningful client-provider interaction. These features of care should guide the development of strategies aimed at helping those in restricted settings, such as Mississippi, to overcome barriers to abortion care following the implementation of abortion bans in many states following the overturn of Roe v. Wade.

Barriers to Healthcare Across Rural Communities-Testing Telehealth as an Alternative Model of Healthcare Service Delivery

Healthcare consumers from rural areas in the United States have inadequate access to healthcare due to a lack of providers, ineffective healthcare networks, and impaired healthcare delivery models. Further, low income, insurance coverage, and transportation are significant challenges limiting rural healthcare consumers’ access to healthcare. Therefore, preventable hospitalizations are more common in rural areas. As a result, healthcare access in rural areas has become a pressing issue for healthcare leaders and the government. Therefore, the author would like to conduct a literature review to assess the barriers in rural areas and establish the framework for a pilot study to propose telehealth as an alternative healthcare service delivery model to improve healthcare accessibility and health promotion.

Exploring Stakeholders' Perspectives on Implementing Universal Germline Testing for Colorectal Cancer: Findings From a Clinical Practice Survey.

New guidelines recommend considering germline genetic testing for all patients with colorectal cancer (CRC). However, there is a lack of data on stakeholders' perspectives on the advantages and barriers of implementing universal germline testing (UGT). This study assessed the perspectives of members of the Collaborative Group of the Americas on Inherited Gastrointestinal Cancer (CGA-IGC) regarding the implementation of UGT for patients with CRC, including readiness, logistics, and barriers. A cross-sectional survey was sent to 317 active members of CGA-IGC. The survey included sections on demographics, clinical practice specialty, established institutional practices for testing, and questions pertaining to support of and barriers to implementing UGT for patients with CRC. Eighty CGA-IGC members (25%) participated, including 42 genetic counselors (53%) and 14 gastroenterologists (18%). Forty-seven (59%) reported an academic medical center as their primary work setting, and most participants (56%) had more than 10 years of clinical practice. Although most participants (73%) supported UGT, 54% indicated that changes in practice would be required before adopting UGT, and 39% indicated that these changes would be challenging to implement. There was support for both genetics and nongenetics providers to order genetic testing, and a majority (57%) supported a standardized multigene panel rather than a customized gene panel. Key barriers to UGT implementation included limited genetics knowledge among nongenetics providers, time-consuming processes for obtaining consent, ordering tests, disclosing results, and lack of insurance coverage. This study demonstrates wide support among hereditary GI cancer experts for implementation of UGT for patients with CRC. However, alternative service delivery models using nongenetics providers should be considered to address the logistical barriers to UGT implementation, particularly the growing demand for genetic testing.

The Impact of Targeted Interventions Aimed to Improve Quality of Life in Patients Receiving Home Parental Nutrition - A Systematic Literature Review.

Home Parenteral Nutrition (HPN) is a specialised therapy offered to people suffering from intestinal failure. Underlying disease, HPN complications and limitations of HPN can significantly impact a person's Quality-of-Life (QOL). The aim of this review was to evaluate the evidence on existing non-surgical/non-pharmacological interventions aimed at improving QOL, clinical, patient-reported and economic outcomes for patients receiving parenteral nutrition therapy at home across adult and paediatric settings. Online databases Medline (Ovid), Embase, and Cinahl were searched to identify studies published between 1937 to 31st March 2022. Identified studies were appraised using the Cochrane Collaboration risk of bias tool and Grading of Recommendations Assessment, Development and Evaluation (GRADE) assessment. Nine studies were included in this review. Interventions were focused on education (4), telemedicine (2), preparation of infusion mixtures (1), Mindfulness-Based Cognitive Therapy (1) and a multi-modal approach (1). Only one study measured QOL before and after the intervention using a validated QOL tool. All studies were assessed at either some, high or critical risk of bias, resulting in low, or very low-quality evidence for the interventions evaluated. The findings from this review highlight the lack of high-quality non-surgical/non-pharmacological studies seeking to improve QOL for people on HPN. As the majority of people receiving HPN are not eligible for surgical or pharmaceutical treatments, higher quality research using clinical trial design, and research focused on improving QOL is needed to inform healthcare managers about the effectiveness (and value) of alternative service delivery models for this vulnerable patient group. This article is protected by copyright. All rights reserved.

'We delivered at home out of fear': Maternity Care in Rural Nigeria During the COVID-19 Pandemic.

The COVID-19 pandemic response overwhelmed health systems, disrupting other services, including maternal health services. The disruptive effects on the utilization of maternal health services in low-resource settings, including Nigeria have not been well documented. We assessed maternal health service utilization, predictors, and childbirth experiences amidst COVID-19 restrictions in a rural community of Kumbotso, Kano State, in northern Nigeria. Using an explanatory mixed methods design, 389 mothers were surveyed in January 2022 using validated interviewer-administered questionnaires, followed by in-depth interviews with a sub-sample (n=20). Data were analyzed using logistic regression models and the framework approach. Less than one-half (n=165, 42.4%) of women utilized maternal health services during the period of COVID-19 restrictions compared with nearly two-thirds (n=237, 65.8%) prior to the period (p<0.05). Non-utilization was mainly due to fear of contracting COVID-19 (n=122, 54.5%), clinic overcrowding (n=43, 19.2%), transportation challenges (n=34, 15.2%), and harassment by security personnel (n=24, 10.7%). The utilization of maternal health services was associated with participant's post-secondary education (aOR=2.06, 95% CI:1.14- 11.40) (p=0.02), and employment type (civil service, aOR=4.60, 95% CI: 1.17-19.74) (p<0.001), business aOR=1.94, 95% CI:1.19- 4.12) (p=0.032) and trading aOR=1.62, 95% CI:1.19-2.94) (p=0.04)). Women with higher household monthly income (≥ N30,000, equivalent to 60 US Dollars) (aOR=1.53, 95% CI:1.13-2.65) (p=0.037), who adhered to COVID-19 preventive measures and utilized maternal health services before the COVID-19 pandemic were more likely to utilize those services during the COVID-19 restrictions. In contrast, mothers of higher parity (≥5 births) were less likely to use maternal health services during the lockdown (aOR=0.30, 95% CI:0.10-0.86) (p=0.03). Utilization of maternal services was also associated with partner education and employment type. The utilization of maternal health services declined during the COVID-19 restrictions. Utilization was hindered by fear of contracting COVID-19, transport challenges, and harassment by security personnel. Maternal and partner characteristics, adherence to COVID-19 preventive measures, and pre-COVID maternity service utilization influenced attendance. There is a need to build resilient health systems and contingent alternative service delivery models for future pandemics.

Something to chat about: An analysis of genetic counseling via asynchronous messaging following direct-to-consumer genetic testing.

Advances in technology, decreasing cost of genetic testing, and growing public interest in genetics marked by an increased uptake of genetic testing, particularly direct-to-consumer genetic testing (DTC-GT), have led to an overwhelming demand for genetic counseling services. As such, various alternative service delivery models have been proposed to increase access to genetic counseling. Some service delivery models, such as asynchronous messaging, remain unexplored in the genetic counseling literature. The purpose of this study was to assess communication during genetic counseling for DTC-GT through asynchronous messaging. A thematic analysis was conducted on 34 de-identified chat transcripts between genetic counselors and clients who underwent DTC-GT. Six categories of communication were identified and were grouped based on communication sources from either the client or the genetic counselor. Categories observed in client communication were motivations for seeking DTC testing and/or genetic counseling services, questions posed to the genetic counselor, responses provided during the session, and psychosocial aspects of the session related to the clients' mental, emotional, social, and spiritual needs. Categories of communication that emerged from the genetic counselors' communications were educational aspects of the session and counseling strategies to address concerns that are not related to educational or informational needs. Most clients had specific questions about variants detected or specific conditions. Many clients asked about appropriate subsequent steps related to additional testing or medical management. Genetic counselors discussed the limitations of DTC-GT and recommendations for clinical grade testing in almost all chat transcripts. In several chats, the genetic counselor provided advice to the client related to minimizing time sorting through likely benign results and refraining from altering medical management. Results suggest that genetic counselors are able to provide genetic information to clients and respond to their mental and emotional needs through asynchronous chat following DTC-GT. Findings from this study provide initial insight into a unique genetic counseling delivery model and reveal the informational and counseling needs of clients following DTC-GT.

Barriers to integrated primary care and specialty mental health services: Perspectives from Latinx and non-Latinx White primary care patients.

Significant disparities in access to mental health care exist in the current mental health system; integrated primary care (IPC) offers an alternative model of service delivery with initial evidence for reducing disparities. Little is known about whether, and how, IPC reduces barriers to mental health services. Here we report on a set of three studies using mixed methodology to explore the perceptions of potential recipients of care regarding barriers to accessing mental health treatment by setting (IPC or specialty mental health [SMH]) and ethnicity (Latinx or non-Latinx White). In Study 1, a main effect of setting indicated IPC patients perceived fewer barriers to accessing IPC than SMH. A setting by ethnicity interaction revealed Latinx patients perceived greater barriers to SMH than non-Latinx White patients. In Study 2, data from qualitative interviews suggested IPC patients found behavioral health treatment in IPC to be accessible and satisfactory. In Study 3, a non-treatment-seeking sample did not endorse a difference in barriers by setting or ethnicity. Overall, it appears IPC patients perceive behavioral health treatment delivered in primary care to be satisfactory, beneficial, and successful in reaching individuals with mental health need who otherwise may not receive care. Non-treatment-seeking individuals with lower psychiatric distress did not identify a difference in barriers between IPC and SMH settings. Findings are consistent with the potential of the IPC setting for reducing barriers to care, although key elements of IPC may need to be addressed to increase acceptability across all population subgroups. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

A Preliminary Investigation of the Reliability of Acoustic Parameters of Voice through Smartphone Recordings in Individuals with Dysphonia.

Telepractice offers the opportunity to receive care at home without risk of exposure to healthcare acquired infections, especially during a pandemic. Hence, establishing the reliability of the diagnosis of dysphonia via a smartphone is fundamental to providing an alternative service delivery model. A total of 20 participants participated in the study. Recordings of sentence-based voice samples were done using a standardized microphone and the software used in labs and on smartphones. Comparisons were made of acoustic and perceptual voice in real-time and recorded samples speech in persons with typical vs pathological voice. Results revealed no significant differences perceptually between real-time voice and recorded voice in individuals with typical and pathological voices. In acoustic analysis, there was no significant difference in Fundamental frequency (F0) and Auditory Voice Quality Index (AVQI) between real-time voice and recorded voice in individuals with typical and pathological voice.

Improving Functional Communication Outcomes in Post-Stroke Aphasia via Telepractice: An Alternative Service Delivery Model for Underserved Populations.

Many persons with aphasia (PWA) have limited access to speech-language treatment (SLT) due to limited funding, speech-language pathologist shortages, geographical barriers, physical disabilities, transportation barriers, and the COVID-19 pandemic. The purpose of this study was to determine if telepractice is an effective and feasible service delivery model for PWA. Ten PWA completed 8 hours of remote treatment over 4 weeks. Synchronous telepractice sessions employed Oral Reading for Language in Aphasia (ORLA) and Conversational Script Training (CST). Pre- and post-assessment outcome measures included the Communication Activities of Daily Living-3 (CADL-3) and the Communication Confidence Rating Scale for Aphasia (CCRSA). Participants completed a telepractice satisfaction survey following post-assessment. All participants demonstrated improvements in CCRSA scores, total words produced correctly on trained CST stimuli, and total words produced correctly on trained ORLA stimuli. No differences were noted in CADL-3 scores. All participants were highly satisfied with telepractice as a service delivery model.

An evidence-based practice guideline of the National Society of Genetic Counselors for telehealth genetic counseling.

There are currently no practice guidelines available for genetic counseling using telehealth modalities. This evidence-based practice guideline was developed in response to increasing use of alternative service delivery models for genetic counseling, specifically telephone and video-based genetic counseling (telehealth genetic counseling or THGC). A recent systematic evidence review (SER) compared outcomes of THGC with in-person genetic counseling and found that for the majority of studied outcomes, THGC was a non-inferior and comparable service delivery model. The SER results were used to develop this guideline. The current and anticipated future use of THGC, including the influence of the COVID-19 pandemic, provides the context for this guideline. Recommendation: The Telehealth Practice Guideline author workgroup conditionally recommends telehealth genetic counseling, either via telephone or video, as a delivery method for genetic counseling. Depending on factors unique to individual healthcare systems and provider and patient populations, THGC may be the only service delivery model available or may be utilized in addition to other service delivery models including in-person genetic counseling. The evidence shows large desirable effects, minor undesirable effects, and increased equity for patients when THGC is available. THGC may reduce or remove existing barriers to patient access to genetic counseling, such as medical conditions and/or disabilities that may affect a patient's ability to travel, inflexible work or school schedules, and lack of reliable transportation, finances, or dependent care. THGC is likely acceptable to key groups impacted by its use and is feasible to implement. Certain patient populations may require additional resources or encounter more barriers in using telemedicine services in general. For these populations, THGC can still be a valuable option if solutions are available.

STUDENT CLINICIAN'S KNOWLEDGE AND PERCEPTION ABOUT TELETHERAPY

The onset of the Covid-19 pandemic has brought drastic change in service delivery among the rehabilitation professionals. Schools for children with special needs and educational and rehabilitation institutions, are offering tele services as an alternative service delivery model, to meet the needs of the individuals with disabilities. Tele-therapy is the application of telecommunications technology to the delivery of speech language pathology and audiology professional services at a distance by linking clinician to client or clinician to clinician for assessment, or intervention. For many clients, clinicians, and student clinicians, this may be their rst experience with tele-therapy. Student clinician's play a very important role as they are directly involved in providing therapeutic services through the online mode. The clinician's knowledge, resources and perceptions are key factors determining the outcomes of therapeutic services. The current study aimed to understand student clinician's knowledge, and perceptions about tele-therapy. The results revealed that most clinicians felt condent and knowledgeable about teletherapy. Majority of the clinicians reported that they were able to achieve the goals set for the clients through tele-therapy. But when asked about their preferences, the results were mixed, with some clinician preferring face to face session and others teletherapy, and also over the use of digital material vs ashcards. Most clinicians reported of holding the child's attention to be one of the major challenges in teletherapy. Some of the other barriers were network connectivity and lack of parental involvement. They also reported that adults with communication disorders benet the most and individuals with hearing impairment benet the least from tele-therapy.

A delivery service model for genetics: The use of a genetic counselor and nurse practitioner team for diagnosis and care in specific condition populations.

Many genetic centers are developing innovative delivery models for services to address the growing need for access to genetics in the setting of a limited genetics-certified workforce. In the literature review, alternative service delivery models-including telehealth and genetic counselor involvement with nongenetics specialty providers-aim to increase efficiency, patient access, and provider satisfaction. This paper outlines a traditional model of pediatric care, with a workflow involving a geneticist and genetic counselor, from preclinic to follow-up. We then present a workflow model of a collaborative team consisting of a genetic counselor and nurse practitioner in condition-specific pediatric clinics. We break down factors influencing the successful implementation of this model, including patient selection, pre-established and adaptive clinic goals, and differentiation of roles of the providers. Potential barriers to generalization and the ongoing success of this clinic model include provider interest in genetics and the necessity for careful triaging by clinicians. Formalized analysis of these clinics has not been performed, though at the presented institution, this clinic model is recognized as an effective way to decrease wait times for patients referred for specific indications and creates an environment that allows providers to specialize, increasing their expertize and confidence in particular genetic areas.

Comparing pretest video genetic education for prostate cancer patients: Do patients need assistance?

5061 Background: Expanded germline genetic testing recommendations for individuals with prostate cancer (PCa) have resulted in increased demand for pre-test genetic education. As a result, alternative service delivery models in genetic counseling (GC) have been suggested. Previous research has shown no difference in genetic testing uptake when video genetic education (VGE) is used rather than face-to-face counseling. However, data is limited when evaluating how VGE is delivered to patients. This study aimed to evaluate the impact of pre-test VGE on genetic testing uptake when facilitated by a GC assistant or self-completed by the patient. Methods: PCa patients referred for GC were contacted for pre-test VGE. Patients were randomized to undergo VGE with a GC assistant via Zoom (assistant-led) or perform VGE on their own via email instructions (patient-led). Assistant-led VGE was scheduled via standard of care, and patient-led VGE involved electronic and phone contact. In both arms, pre-test VGE included administrating family history collection via electronic software and viewing of informational genetics video. VGE completion and genetic testing uptake was the primary outcome measured for all participants. Initial pilot data was presented previously. This analysis represents the entire study period outcome. Data analysis used t-test, Fisher’s exact and chi square. Results: From 10/1/2020-12/31/2021, 266 PCa patients were referred. In total, 254 were randomized, with 130 in the assistant-led intervention and 124 randomized to the patient-led arm. Technological limitations, loss to follow up, and procedural withdrawals resulted in 41 (31.5%) patients in the assistant-led arm and 65 (52.4%) in the self-led arm. The primary reason for discontinuing the process was lack of patient response to contact to schedule their genetics visit (n = 109, 35 patient-led, 74 assistant-led). There was significantly more loss to follow up in the assistant-led arm versus the self-led arm (p &lt; 0.001). Of those who completed VGE, the median age was 66 years, with no difference between the two arms (p = 0.66). Participants primary identified as white (n = 96, 91%) and non-Hispanic (n = 100, 94%). There was no difference in uptake of genetic testing (p = 0.09) between patient and assistant led VGE. Conclusions: A randomized intervention suggests no difference in genetic testing uptake when pre-test VGE occurs with an assistant or is patient-led. Analyses of satisfaction, decision conflict, and knowledge are needed to evaluate if patient-led VGE is a suitable alternative to GC. Loss to follow up given standard of care scheduling approaches for assistant-led VGE suggests pre-test VGE may be better delivered during oncology visits. Additional evaluation of the facilitators and barriers, in addition to larger multi-center studies, are required to consider patient-led pre-test VGE as a primary method of pre-testing genetic education.

Mainstreaming Genetic Testing for Epithelial Ovarian Cancer by Oncology Providers: A Survey of Current Practice.

With limitations in early detection and poor treatment response, ovarian cancer is associated with significant morbidity and mortality. Up to 25% of epithelial ovarian cancer (EOC) is related to a hereditary predisposition. Current National Comprehensive Cancer Network guidelines recommend that all individuals diagnosed with EOC be offered germline genetic testing. Although this would ideally be performed by genetics professionals, a shortage of genetic counselors can affect timely access to these services. This study sought to investigate the current genetic testing practices of oncology providers to determine the feasibility of oncologist-led genetic testing for patients with EOC. A survey was distributed to members of the Society of Gynecologic Oncologists with questions regarding timing, frequency, and type of cancer genetic testing, referrals to genetics professionals, confidence with aspects of genetic testing, and any barriers to these processes. We received 170 evaluable responses. Eighty-five percent of providers always ordered genetic testing for patients with EOC. Most providers ordered germline multigene panel testing (95.8%), generally at diagnosis (64.5%). Provider confidence with the genetic testing process was generally high and significantly differed by providers' testing practices, namely, respondents who reported always ordering genetic testing tended to be more confident in ordering testing (P = .008), interpreting results (P = .005), and counseling a patient (P = .002). Patient disinterest and concerns for insurance coverage were commonly cited as barriers to testing and referrals. The findings from this study suggest that oncologist-led genetic testing for patients with EOC, with referrals to genetics professionals when appropriate, has the potential to be a viable alternative service delivery model to increase access to genetic testing for patients diagnosed with EOC.