Evaluating Triage to Genetic Counseling Using an Online Reproductive Genetics Module

The American College of Obstetricians and Gynecologists recommends genetic screening for all pregnant women. As clinical recommendations broaden and demand for prenatal screening increases, obstetric practitioners report time constraints and lack of genetics knowledge as challenges to providing sufficient pretest education. These challenges in offering routine screening are further compounded by the inequities in access to genetic counseling and testing. Thus, alternative education and service delivery models have emerged to meet the demands for prenatal genetics education and help mitigate challenges surrounding access. At UTHealth Houston, an online triage and education module, the Prenatal Genetics Education Program (PGEP), was created for patients with low-risk pregnancies to address existing gaps in care. While there is research on the barriers to genetic services, there is minimal research on genetics education modules’ impact on risk assessment and medical care, specifically in the realm of prenatal genetic counseling. This retrospective chart review characterized the patient population triaged to genetic counseling by an online prenatal education tool and examined how genetic counseling impacts prenatal care compared to those who only complete an online module. Traditional genetic indications, such as a concerning family history, in addition to less traditional indications, such as those who are being offered genetic screening during a pregnancy for the first time should be considered when implementing a triage tool. Of the 896 patients who were offered genetic counseling following PGEP, 216 completed genetic counseling. The majority had a change in prenatal care, such as changes in risk assessment, test selection, or prenatal management, that was not addressed or offered in PGEP. Nearly a third of the 216 participants who completed genetic counseling had a positive genetic test result. The majority of these positive results would not have been detected with routine prenatal screening and without an appointment with a genetic counselor. Overall, PGEP led to the equitable triage of pregnant patients to genetic counseling and patients who were triaged to genetic counseling expressed high levels of satisfaction with the module. Results of this study can help provide direction in the implementation of a prenatal genetics triage tool to streamline the prenatal genetic screening process and to ensure that patients have access to genetic services.