Background: Genetic Counseling (GC) for hereditary breast and ovarian cancer is concentrated in elite medical centers but is not offered in most public hospitals. GC may be extended to the underserved by phone or video conference, but the efficacy of these delivery modes in this population is unknown. We compared GC delivered in person, by phone, or via video conference for public hospital patients with regard to knowledge, cancer-specific distress, decisional conflict, risk perception, and satisfaction.

Methods: Partnering with 3 public hospitals, we conducted a partially randomized preference noninferiority trial with high-risk English-, Spanish-, and Cantonese-speaking patients assigned by patient preference or randomization to three counseling modes: in-person, phone, or video. Surveys were administered pre and post counseling. Randomized participants were compared by GC mode with respect to study outcomes.

Results: Based on 23,633 family history forms, 1,574 patients were eligible with 679 assigned to a GC mode; of 394 randomized, 322 attended genetic counseling, and 312 completed the final survey. After counseling mean knowledge scores increased, and cancer-specific distress and decisional conflict decreased. Phone and video were non-inferior to in-person counseling. Participants reported a lower rate of the belief that they are more likely than other people to have a breast cancer gene mutation post-counseling (41% vs. 52% pre-counseling, p=0.0004), with no significant differences by mode. Nearly all (91%) of participants in each mode reported high satisfaction with counseling.

Conclusion: Phone and video counseling are as effective as in-person GC, creating new opportunities for access to GC in public hospitals.