Critical appraisal:Buchanan AH, Datta SK, Skinner CS, Hollowell GP, Beresford HF, Freeland T, et al 2015

From Clinical Guidelines Wiki

Critical Appraisal

Article being appraised

Buchanan AH, Datta SK, Skinner CS, Hollowell GP, Beresford HF, Freeland T, et al. Randomized Trial of Telegenetics vs. In-Person Cancer Genetic Counseling: Cost, Patient Satisfaction and Attendance. J Genet Couns 2015 Apr 3 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/25833335.


Applicable clinical question

Key Facts

Study Design

randomised controlled trial

Study aims:

To compare cost, satisfaction and attendance to genetic counselling sessions (GCS) using different modes of delivery - face to face versus telemedicine (videoconferencing).

Number of Patients:

162

Individuals referred for Cancer Genetic Counseling (CGC) between August 2008 and January 2011 from four oncology units linked with Dukes Cancer Network, USA. Patients were contacted for verbal consent to enter the study, then radomised to either face to face CGC or Telemedicine CGC at their local clinic.There was no stratification based on demographics of participants. a single GC saw all participants in both groups.
Reported outcome(s):

Costs were more than halved using telemedicine. Patient satisifaction was high with both services and did not differ between the two groups. However face to face patients were more likely to attend CGC sessions than telemedicine patients. There was an association between participant lack of comfort with computers and lower attendance rate for telemedicine.

Results of outcome(s):

Cost was $106 with Telemedicine versus $244 with face to face CGC. However the reason for increased costs in face to face group was the driving time and distance. The actual GCS time spent in each modality was almost identical. Patient satisfaction did not differ between groups. 91-95% (face to face) and 96% (telehealth) of participants reported good quality technology during CGC sessions with clarity of picture and sound. Only 18% of participants required assistance with the equipment. 98% felt comfortable with the telemedicine modality for CGC, hower 32% would have preferred face to face.Patients were significanlty more like to attend with Face to face than with telemedicine (89% vs 79%) - however lower attendance was related to greater discomfort with computer technology.

Comments on results:

Whilst this study is in the field of genetic counselling - education and information provision as opposed to assessment and consultation of cancer patients, it clearly demonstrated cost savings and patient satisfaction with this technology.

Includes an economic evaluation

yes

Evidence ratings

Level of evidence

II

Risk of bias
Low risk of bias Comments: Whilst this study is in the field of genetic counselling - education and information provision as opposed to assessment and consultation of cancer patients, it clearly demonstrated cost savings and patient satisfaction with this technology.

Risk of bias assessment: randomised controlled trial

Was the trial double-blinded?
Outcomes not blinded, substantial side-effects, or not reported.
Was the treatment allocation schedule concealed?
No concealment or unclear (e.g. no approach described, open randomisation lists, person doing recruitment tossing a coin).
Were all randomised participants included in the analysis?
No exclusions or survival analysis used with all subjects included (>95% follow-up for all groups).
The field below is not considered when calculating the risk of bias rating
How was the allocation schedule generated?
Adequate (e.g. random number table, computer random generator, coin tossing, card shuffling)
Size of effect
2 Reason for decision: This article outlines the confidence intervals for the demographics which were biased toward the face to face group despite randomisation. However this is the only randomized trial for CGC using telemedicine versus face to face modality.
Relevance of evidence
2 Additional comments: A reasonable number of particpants (162) were randomised to each treatment modality. However there were significant differences in demographics between the groups despite randomisation. There was greater number of people with higher education level, higher comfort with computers, greater number of white vs non white races, greater income in the face to face group, less unemployed and more married and this may have impacted on the satisfaction with telemedicine. The costs calculated included equipment and software at each site, labour, maintenance, training time, clinic personnel and genetic counsellor time for the telemedicine group. Travel time, genetic counsellor were the costs calculated for the face to face group. A survey of patient satisfaction was conducted 1 week post each telemedicine session using Cronbach's alphas for VSQ and GCSS tools with Bonferroni used to corect multiple comparisons. Attendance was calculated and again Bonferroni was use to corrrect multiple comparisons - race, income, computer comfort, college education, employment status and marriage status.
Result of appraisal

Jutta's tick icon.png Included




Completed by

Peggy Briggs


Jutta's tick icon.png This appraisal has been completed.


Article
Buchanan AH, Datta SK, Skinner CS, Hollowell GP, Beresford HF, Freeland T, et al. Randomized Trial of Telegenetics vs. In-Person Cancer Genetic Counseling: Cost, Patient Satisfaction and Attendance. J Genet Couns 2015 Apr 3 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/25833335.
Assigned to
User:Peggy.briggs
Topic area
Guidelines:
Property "Appraisal topic" (as page type) with input value "Guidelines:" contains invalid characters or is incomplete and therefore can cause unexpected results during a query or annotation process.
Clinical question
Form
Form:Critical appraisal


Section below only relevant for Cancer Council Project Officer

Edit appraisal assignment