Table 4. In-person visit activities compared among general, cancer, cardiovascular, prenatal, and all specialists combined (cancer, cardiovascular, and prenatal).
| Variable | General (n=136) | Cancer (n=252) | Cardio (n=103) | Prenatal (n=92) | Specialties (n=447) | P valuea | P valueb |
|---|---|---|---|---|---|---|---|
| N (%) | N (%) | N (%) | N (%) | N (%) | |||
|
Total in-person score (of 77 maximum) | |||||||
| Mean±s.d. | 20±6 | 20±6 | 21±6 | 25±6 | 21±6 | 0.64 | 0.75 |
| Median (range) | 20 (4–37) | 20 (6–37) | 21 (11–41) | 25 (11–42) | 22 (6–42) | ||
|
Time spent on in-person activities | |||||||
| 0–4 min | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0.34 | 0.94 |
| 5–15 min | 5 (3.7) | 1 (0.4) | 2 (1.9) | 0 (0.0) | 3 (0.7) | ||
| 16–30 min | 30 (22.1) | 43 (17.1) | 37 (35.9) | 30 (32.6) | 110 (24.6) | ||
| 31–60 min | 82 (60.3) | 171 (67.9) | 56 (54.4) | 57 (62.0) | 284 (63.5) | ||
| >60 min | 19 (14.0) | 37 (14.7) | 8 (7.8) | 5 (5.4) | 50 (11.2) | ||
|
Minimum time spent | |||||||
| Mean±s.d. | 31±14 | 33±13 | 27±12 | 28±10 | 30±12 | ||
| Median (range) | 31 (5–60) | 31 (5–60) | 31 (5–60) | 31 (16–60) | 31 (5–60) | ||
| Basic history collection | 126 (92.6) | 242 (96.0) | 103 (100) | 91 (98.9) | 436 (97.5) | 0.10 (s) | 0.08 |
| Social history collection | 101 (74.3) | 121 (48.0) | 75 (72.8) | 17 (18.5) | 213 (47.7) | 0.12 | 0.13 |
| Reproductive history collection | 3 (2.2) | 171 (67.9) | 5 (4.9) | 86 (93.5) | 262 (58.6) | <0.001 | 0.012 |
| Pregnancy/birth history collection | 66 (48.5) | 3 (1.2) | 48 (46.6) | 42 (45.7) | 93 (20.8) | 0.024 | 0.09 |
| Developmental history collection | 89 (65.4) | 5 (2.0) | 15 (14.6) | 6 (6.5) | 26 (5.8) | 0.004 | 0.002 |
| Directed physical assessment | 17 (12.5) | 91 (36.1) | 64 (62.1) | 5 (5.4) | 160 (35.8) | 0.37 | 0.48 |
| Assess Ohio Department of Health questions | 46 (33.8) | 1 (0.4) | 5 (4.9) | 0 | 6 (1.3) | 0.001 (s) | <0.001 |
| Collect evaluation/screening history | 50 (36.8) | 230 (91.3) | 88 (85.4) | 77 (83.7) | 395 (88.4) | 0.040 | 0.003 |
| Review outside records | 12 (8.8) | 28 (11.1) | 24 (23.3) | 8 (8.7) | 60 (13.4) | 0.36 | 0.52 |
| Collect family history | 124 (91.2) | 237 (94.0) | 94 (91.3) | 91 (98.9) | 422 (94.4) | 0.67 | 0.72 |
| Create differential diagnosis | 87 (64.0) | 226 (89.7) | 86 (83.5) | 61 (66.3) | 373 (83.4) | 0.31 | 0.19 |
| Run risk models for patient | 0 | 78 (31.0) | 0 | 1 (1.1) | 79 (17.7) | 0.027 (s) | 0.19 (s) |
| Run risk models for family member(s) | 0 | 13 (5.2) | 0 | 1 (1.1) | 14 (3.1) | 0.27 (s) | 0.31 (s) |
| Assess empiric risk for patient | 36 (26.5) | 67 (26.6) | 89 (86.4) | 48 (52.2) | 204 (45.6) | 0.05 | 0.22 |
| Assess empiric risk for family member(s) | 39 (28.7) | 48 (19.0) | 77 (74.8) | 38 (41.3) | 163 (36.5) | 0.05 | 0.50 |
| Discuss aneuploidy risk | 1 (0.7) | 0 | 1 (1.0) | 71 (77.2) | 72 (16.1) | <0.001 (s) | 0.55 |
| Discuss previous testing | 73 (53.7) | 82 (32.5) | 24 (23.3) | 53 (57.6) | 159 (35.6) | 0.010 | 0.06 |
| Educate about genetic conditions | 96 (70.6) | 236 (93.7) | 103 (100) | 87 (94.6) | 426 (95.3) | 0.013 (s) | 0.003 |
| Educate about genetics | 110 (80.9) | 134 (53.2) | 96 (93.2) | 92 (100) | 322 (72.0) | 0.40 (s) | 0.62 |
| Discuss inheritance | 75 (55.1) | 223 (88.5) | 87 (84.5) | 87 (94.6) | 397 (88.8) | 0.12 | 0.027 |
| Discuss recurrence risk | 75 (55.1) | 103 (40.9) | 66 (64.1) | 56 (60.9) | 225 (50.3) | 0.81 | 0.70 |
| Review medical management options | 37 (27.2) | 218 (86.5) | 64 (62.1) | 20 (21.7) | 302 (67.6) | <0.001 | 0.047 |
| Review pregnancy management options | 0 | 6 (2.4) | 2 (1.9) | 70 (76.1) | 78 (17.4) | <0.001 (s) | 0.30 (s) |
| Discuss genetic testing options | 93 (68.4) | 202 (80.2) | 83 (80.6) | 89 (96.7) | 374 (83.7) | 0.038 | 0.08 |
| Explain genetic testing process | 86 (63.2) | 189 (75.0) | 72 (69.9) | 81 (88.0) | 342 (76.5) | 0.27 | 0.16 |
| Review GINA | 14 (10.3) | 62 (24.6) | 8 (7.8) | 0 | 70 (15.7) | 0.14 (s) | 0.86 |
| Discuss follow-up plan | 121 (89.0) | 212 (84.1) | 75 (72.8) | 85 (92.4) | 372 (83.2) | 0.13 | 0.30 |
| Psychosocial assessment | 49 (36.0) | 143 (56.7) | 27 (26.2) | 44 (47.8) | 214 (47.9) | 0.87 | 0.71 |
| Psychosocial counselling | 43 (31.6) | 116 (46.0) | 32 (31.1) | 65 (70.7) | 213 (47.7) | 0.58 | 0.46 |
| Provide resources | 23 (16.9) | 78 (31.0) | 23 (22.3) | 17 (18.5) | 118 (26.4) | 0.57 | 0.30 |
| Consent for genetic testing | 41 (30.1) | 171 (67.9) | 38 (36.9) | 62 (67.4) | 271 (60.6) | 0.029 | 0.02 |
| Complete test requisition | 18 (13.2) | 123 (48.8) | 12 (11.7) | 33 (35.9) | 168 (37.6) | 0.36 | 0.35 |
| Request outside records | 10 (7.4) | 13 (5.2) | 8 (7.8) | 0 | 21 (4.7) | 0.30 (s) | 0.39 |
| Take patient photos | 29 (21.3) | 1 (0.4) | 3 (2.9) | 0 | 4 (0.9) | 0.05 (s) | 0.004 |
| Language barrier/interpreter | 8 (5.9) | 3 (1.2) | 5 (4.9) | 6 (6.5) | 14 (3.1) | 0.19 | 0.39 |
| Make referrals to specialists | 23 (16.9) | 19 (7.5) | 14 (13.6) | 14 (15.2) | 47 (10.5) | 0.32 | 0.14 |
| Spend time waiting for the MD | 63 (46.3) | 17 (6.7) | 7 (6.8) | 2 (2.2) | 26 (5.8) | 0.033 | 0.004 |
Abbreviation: GINA, Genetic Information Non-Discrimination Act. (s) Could not be analysed as a binary outcome so a 0–1 score was analysed instead.
a
Overall P value seeking differences among four groups (i.e., comparison among columns 1, 2, 3 and 4).
b
P value comparing general with all specialists (i.e., comparison of column 1 and column 5). Statistically significant P values are shown in bold.