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Randomized Trial of Telegenetics vs. In-Person Cancer Genetic Counseling: Cost, Patient Satisfaction and Attendance
Telegenetics—genetic counseling via live videoconferencing—can improve access to cancer genetic counseling (CGC) in underserved areas, but studies on cancer telegenetics have not applied randomized methodology or assessed cost. We report cost, patient satisfaction and CGC attendance from a randomized trial comparing telegenetics with in-person CGC among individuals referred to CGC in four rural oncology clinics. Participants (
n
= 162) were randomized to receive CGC at their local oncology clinic in-person or via telegenetics. Cost analyses included telegenetics system; mileage; and personnel costs for genetic counselor, IT specialist, and clinic personnel. CGC attendance was tracked via study database. Patient satisfaction was assessed 1 week post-CGC via telephone survey using validated scales. Total costs were $106 per telegenetics patient and $244 per in-person patient. Patient satisfaction did not differ by group on either satisfaction scale. In-person patients were significantly more likely to attend CGC than telegenetics patients (89 vs. 79 %,
p
= 0.03), with bivariate analyses showing an association between lesser computer comfort and lower attendance rate (Chi-square = 5.49,
p
= 0.02). Our randomized trial of telegenetics vs. in-person counseling found that telegenetics cost less than in-person counseling, with high satisfaction among those who attended. This study provides support for future randomized trials comparing multiple service delivery models on longer-term psychosocial and behavioral outcomes.
Journal Article
Exploring new horizons in career counselling : turning challenge into opportunities
\"This book brings together eminent global theorists and practitioners to share their views on the evolution of career counselling in recent decades. Multiple changes of a fundamental and complex nature, as well as related challenges in the world of work, have necessitated career counselling to undergo such an evolution. The authors examine the future nature and scope of new directions in the field of career counselling psychology and they critically reflect on, as well as promote the predominant theoretical and conceptual framework of the field of career counselling. The latest models and methods in and for the 21st century are explored and teased out, including Mark Savickas\\2019 proposal to shift the focus in interventions from conceptualising the self as content to seeing the self as a process. This approach is in keeping with the notion of career as a story and consistent with leading theories such as Jean Guichard\\2019s self-construction framework and the life design paradigm. The authors deliver an avant garde text that is easy to read and use without diluting the conceptual and terminological complexities of the field.\" -- Publisher's website.
Book
Culturally Relevant Ethical Decision-Making in Counseling
Culturally Relevant Ethical Decision-Making in Counseling presents a hermeneutic orientation and framework to address contextual issues in ethical decision-making in counseling and psychotherapy. Authors Rick Houser, Felicia L. Wilczenski, and Mary Anna Ham incorporate broad perspectives of ethical theories which are grounded in various worldviews and sensitive to cultural issues.
eBook
The heart of counseling : counseling skills through therapeutic relationships
\"More than any other text on the market, The Heart of Counseling is effective in helping students to understand the importance of therapeutic relationships and to develop the qualities that make the therapeutic relationships they build with clients the foundation of healing. In these pages, students come to see how all skills arise from and are directly related to the counselor's development and to building therapeutic relationships. Student learning ranges from therapeutic listening and empathy to structuring sessions, from explaining counseling to clients and caregivers to providing wrap-around services, and ultimately to experiencing therapeutic relationships as the foundation of professional and personal growth. The Heart of Counseling includes: extensive case studies and discussions applying skills in school and agency settings skill-based specificity for abstract concepts of change through therapeutic relationship exploration of counseling theories and tasks within and extending from core counseling skillsvideos that bring each chapter to life test banks, instructor's manuals, syllabi, and guidance for learning-outcomes assessments for professors \"-- Provided by publisher.
Book
Asesoramiento psicológico en la educación superior portuguesa: ¿cuales son las necesidades de los estudiantes?
Este estudio explora las necesidades de asesoramiento de los estudiantes que asisten a la educación superior portuguesa. Específicamente, se encuesto en línea una muestra de conveniencia de 375 estudiantes con la Encuesta de Necesidades Estudiantiles. Los resultados descriptivos indicaron que \"superar la dilación\", \"estrategias de búsqueda de empleo\" y \"habilidades de gestión del tiempo\" eran sus principales preocupaciones. Los resultados inferenciales indicaron diferencias según la información personal y académica y las condiciones de vida actuales, particularmente, en lo que respecta a las necesidades de asesoramiento personal. Además, un análisis de regresión lineal encontró que el género, la satisfacción académica y la satisfacción con las condiciones de vida actuales tenían un efecto predictivo sobre las necesidades de asesoramiento, y que los estudiantes tenían preferencia por el asesoramiento individual. Se sacan conclusiones sobre la importancia de desarrollar intervenciones dirigidas a clientes específicos.
Journal Article
Physical Activity Promotion in the Health Care System
Physical activity (PA) and exercise training (ET) have great potential in the prevention, management, and rehabilitation of a variety of diseases, but this potential has not been fully realized in clinical practice. The health care system (HCS) could do much more to support patients in increasing their PA and ET. However, counseling on ET is not used widely by the HCS owing partly to attitudes but mainly to practical obstacles. Extensive searches of MEDLINE, the Cochrane Library, the Database of Abstracts of Reviews of Effects, and ScienceDirect for literature published between January 1, 2000, and January 31, 2013, provided data to assess the critical characteristics of ET counseling. The evidence reveals that especially brief ET counseling is an efficient, effective, and cost-effective means to increase PA and ET and to bring considerable clinical benefits to various patient groups. Furthermore, it can be practiced as part of the routine work of the HCS. However, there is a need and feasible means to increase the use and improve the quality of ET counseling. To include PA and ET promotion as important means of comprehensive health care and disease management, a fundamental change is needed. Because exercise is medicine, it should be seen and dealt with in the same ways as pharmaceuticals and other medical interventions regarding the basic and continuing education and training of health care personnel and processes to assess its needs and to prescribe and deliver it, to reimburse the services related to it, and to fund research on its efficacy, effectiveness, feasibility, and interactions and comparability with other preventive, therapeutic, and rehabilitative modalities. This change requires credible, strong, and skillful advocacy inside the medical community and the HCS.
Journal Article
Recontacting patients in clinical genetics services: recommendations of the European Society of Human Genetics
Technological advances have increased the availability of genomic data in research and the clinic. If, over time, interpretation of the significance of the data changes, or new information becomes available, the question arises as to whether recontacting the patient and/or family is indicated. The Public and Professional Policy Committee of the European Society of Human Genetics (ESHG), together with research groups from the UK and the Netherlands, developed recommendations on recontacting which, after public consultation, have been endorsed by ESHG Board. In clinical genetics, recontacting for updating patients with new, clinically significant information related to their diagnosis or previous genetic testing may be justifiable and, where possible, desirable. Consensus about the type of information that should trigger recontacting converges around its clinical and personal utility. The organization of recontacting procedures and policies in current health care systems is challenging. It should be sustainable, commensurate with previously obtained consent, and a shared responsibility between healthcare providers, laboratories, patients, and other stakeholders. Optimal use of the limited clinical resources currently available is needed. Allocation of dedicated resources for recontacting should be considered. Finally, there is a need for more evidence, including economic and utility of information for people, to inform which strategies provide the most cost-effective use of healthcare resources for recontacting.
Journal Article