Critical appraisal:Buchanan AH, Datta SK, Skinner CS, Hollowell GP, Beresford HF, Freeland T, et al 2015 1

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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 cancer telegenetics with in-person CGC on short-term process measures: cost, patient satisfaction, and genetic counseling attendance.

Number of Patients:

162

Allocated to TELEGENETICS (n=81)
Allocated to IN-PERSON CGC (n=81)
Reported outcome(s):

Telegenetics System Performance
Per-Patient Costs
Patient Satisfaction
Genetic Counseling Attendance

Results of outcome(s):

Telegenetics System Performance: 15 % (n=11) were hampered by technical problems, including 7% in which a counseling session could not be completed
Per-Patient Costs: Total costs to provide CGC were $106.19 per telegenetics patient and $244.33 per in-person patient.
Patient Satisfaction: Satisfaction with CGC was high in both groups (no significant difference by group)
Genetic Counseling Attendance: Participants assigned to in-person CGC were significantly more likely to attend their appointment than their telegenetics counterparts (89 vs. 79 %, p=0.03).

Comments on results:

Cost difference was driven primarily by the genetic counselor’s travel cost (in mileage reimbursement and personnel cost while traveling); cost for the genetic counselor’s patient care time was nearly identical between groups. Telegenetics system and clinic personnel costs had minimal impacts on telegenetics cost.

Includes an economic evaluation

yes

Evidence ratings

Level of evidence

II

Risk of bias
High risk of bias Comments: Please replace this text and include any additional comments in regards to your quality rating

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?
Too many exclusions, differential loss in comparison groups, or not reported.
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
5 Reason for decision: Not available for cost analysis
Relevance of evidence
2 Additional comments: Included cost data but not from the patient perspective.
Result of appraisal

Jutta's tick icon.png Included




Completed by

Dr Lisa Mackenzie


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.
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