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Virtual visits benefit patients who have…
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Transportation issues due to:
Geographic distances Adverse weather conditions Car issues (not licensed to drive and/or lack of a car) Limited finances (not able to afford cost of gasoline/travel)
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Significant health issues:
Medical condition(s), especially if impacts mobility, that make travel to clinic visit difficult Cognitive and/or psychological issues that make clinic visit stressful/difficult Life‐limiting condition
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Work issues:
Inflexible work hours/schedule Problems getting approval for time off work or not wanting to make request for privacy reasons Limited time off from work and want to preserve hours for vacation/other commitments Financial issues and cannot afford not being paid if time off not covered
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Childcare, eldercare, or relative care issues:
Lack of childcare coverage and would either not be able to attend clinic visit or have to bring child(ren) Responsibilities for parent/partner/relative who require care and/or cannot be left unattended
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School/Sports/Extracurricular Activities:
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Family members in different locations:
Allows multiple family members to simultaneously receive genetic counseling/services Enables family members in different states/countries to participate in the clinic visit Can facilitate cascade screening of at‐risk relatives
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Virtual visits challenge patients who have…
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Technological device issues:
May not have device for economic or personal reasons May have device that is not adequate for virtual visit (e.g. runs out of battery power, malfunctions) May not know how to use device for virtual visit
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Internet access and connectivity issues:
May not have Internet access May have Internet access but not adequate connectivity May have difficulties hearing questions and responses due to poor connectivity, resulting in multiple requests to repeat information. Therefore, may not obtain complete information and/or provided information may be misunderstood May result in less information communicated by both patient and clinician because of the effort it takes May take more time for clinic visit due to delays in launching visit, poor or dropped connections Connectivity challenges may result in having to convert virtual visit to phone visit
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Video quality issues:
Screen positioning issues and changing views can make it difficult to see patient Pets and children walking in front of camera can obscure view If cell phones being used, small sizes of images can make it difficult for clinicians and patients to see each other and for patients to see content (e.g. if screen share function is available and being used to show pedigree, counseling aids)
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Distractions:
Pets and children may require attention May be engaged in other tasks (e.g., driving, watching children) and not fully paying attention
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Emotional support needs:
May be less comfortable and find it harder to convey emotions in a virtual setting Information about genetic condition/supportive resources cannot readily be provided and will either need to be downloaded by patient or mailed by clinic
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Privacy concerns:
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Inability to complete the additional tasks required for a virtual visit:
May not have read the instructions in advance and/or may not have taken the time to download the software for the video visit, which delays the start of the visit May have read but not understood instructions for downloading the software and/or logging on to visit. Understanding of instructions is likely more difficult if a patient has cognitive issues, limited education or is non‐English speaking Genetic testing tasks (e.g. completion of forms and sample collection) may not be understood or completed, resulting in testing being delayed or not done
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