Although pre-test genetic counseling is widely recommended and has come to dominate genetic counseling practice, tailored results-focused genetic counseling could both increase genetic counseling efficiency and improve genetic counseling outcomes for the growing number of patients seeking genetic testing for recommended genome-guided medical management. This study will test that hypothesis in adults referred for cardiovascular genetic counseling and testing at the Johns Hopkins Center for Inherited Heart Diseases. This study is a three-arm randomized clinical trial to evaluate two complementary approaches to shifting the primary genetic counseling session to post-test for 510 adults with two broad cardiovascular genetic counseling indications: diagnostic panel testing and family-specific variant testing. The investigators will compare usual care (pre-test genetic counseling appointment, results returned by phone / electronic health record) with online video-based pre-test tailored genetic education with an optional (efficiency arm) or required (flipped arm) phone call with a genetic counselor followed by a post-test genetic counseling appointment. The investigators hypothesize that post-test genetic counseling will: 1) increase efficiency, 2) promote patient empowerment and adherence, and 3) have similar genetic test-associated psychosocial impact.
Age range
18 Years
Sex
ALL
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Change in empowerment as measured on the Genetic Counseling Outcomes Scale (GCOS)
Timeframe: Baseline up to 2-weeks after genetic counseling result appointment / disclosure
Anxiety as measured on the Hospital Anxiety and Depression Scale (HADS)
Timeframe: 6-months post results disclosure
Medical adherence as assessed by proportion of completed screening tests
Timeframe: 6-months post results disclosure
Efficiency as assessed by minutes of direct counseling time
Timeframe: Up to 6-months post results disclosure