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COVID workflow adjustments impact where, when, and how genetic counseling was delivered early in the pandemic

Poster presented at the 2020 National Society of Genetic Counselors Annual Conference

Authors: Cary Armstrong, Kiley Johnson, Colleen Caleshu

Background: The coronavirus pandemic (COVID) had major implications for the provision of medical care in the spring of 2020 with many non-emergent forms of care halted or modified. Telehealth genetic counseling companies that provide services to multiple entities have insight into the range of impacts in care occurring at different hospitals, clinics, and laboratories.

Purpose: We sought to investigate the nature, frequency, and extent of modifications to care made by organizations serviced by a national telehealth genetic counseling company.

Methods: Changes in care were communicated by clinics and laboratories to the telehealth organization as they were made. The telehealth organization updated standard operating procedures (SOPs) to reflect these changes. We performed a retrospective review of COVID-related SOP modifications, extracting data on the nature, frequency, and extent of changes.

Results: A minority of organizations serviced by the telehealth genetic counseling organization reported COVID-related modifications. This included 2 laboratories and 6 clinics. The majority were oncology-related (6/8), with the remainder covering reproductive genetics (2/6). Nearly all (7/8) made changes in sample collection with 6 increasing the use of saliva samples and one starting saliva collection for the first time. Due to these changes in sample collection, two oncology practices stopped offering RNA sequencing. Three clinics had changes affecting nursing or administrative staff involved in care of genetic counseling patients, including furloughs and reassignment to COVID-related care. Three clinics that used to have telehealth genetic counseling provided in their clinical space moved many (though not all) of the telehealth visits to the patient’s home. Decisions about whether telehealth genetic counseling would be delivered in the clinic or in the patient’s home were guided by whether the patient had urgent needs, such as surgical decision-making, and whether the patient had other appointments that required them to come into the clinic. Two clinics switched from video-based genetic counseling in clinic to telephone-based, and another delayed a move from telephone-based to video-based.

Conclusions: The COVID pandemic led to changes in sample collection and testing offered, as well as how, where, and when genetic counseling was delivered. This is likely an underestimate of care changes since many clinics and laboratories likely made changes that did not need to be reported directly to the telehealth genetic counseling organization.

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