Educational Video as an Alternative to Pretest In-Person Genetic Counseling in Candidates for Cancer Genetic Testing: A Randomized Controlled Noninferiority Trial

abstract

PURPOSE ¿ The purpose ot this study was to assess the effectiveness of an educational video compared to in-person genetic counseling for cancer genetic testing candidates. Genetic cancer risk assessment is essential for tailoring oncological treatment, identifying individuals at higher risk of cancer, implementing risk-reduction strategies, and enabling family cascade testing. Pretest genetic counseling facilitates an individual¿s informed decision making and reduces anxiety. However, the availability of genetics specialists is limited in constrained resource settings.METHODS ¿ We conducted a randomized controlled noninferiority clinical trial comparing an educational video (intervention arm) with in-person (control arm) genetic counseling for cancer genetic testing candidates. The main outcome was genetic testing acceptance, requiring the 95% CI around the intervention difference to be less than (¿)10 percentage points to claim noninferiority. Secondary outcomes included genetic knowledge, anxiety, and satisfaction. RESULTS ¿ We included 250 participants who met criteria for cancer genetic testing, with a mean age of 47.9 years (standard deviation, 12.7); 86.4% were women. All participants in both arms accepted genetic testing (difference = 0% [95% CI, ¿0.04% to 0%]; P = 1.0). Knowledge improved in both groups: score increments were 20 (95% CI, 16 to 24; P < .05) in the control arm and 16 (95% CI, 12 to 20; P < .05) in the intervention arm. Anxiety scores decreased: ¿0.58 (95% CI, ¿0.09 to ¿1.08; P = .01) in the control arm and ¿0.75 (95% CI, ¿0.42 to ¿0.08; P < .05) in the intervention arm. Satisfaction levels were 97.5% and 92.5%, respectively (P = .34).CONCLUSION ¿ The educational video is noninferior to in-person genetic counseling for genetic testing acceptance, improves genetic knowledge, and reduces anxiety. These findings support using educational videos to address the shortage of genetic counseling professionals. © 2025 American Society of Clinical Oncology