Telehealth utilization and cancer genetic testing discussion and uptake in US adults.

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564 Background: Since the 2019 COVID pandemic, telehealth has been increasingly adopted in the delivery of healthcare services. While telehealth offers the potential to overcome geographical barriers to care, its impact on the discussions about cancer genetic testing has been underexplored. This study assessed the relationships between telehealth utilization and cancer genetic testing discussion and uptake among adults in the US. Methods: We conducted a secondary data analysis of the 2023 National Health Interview Survey (NHIS) that used multistage probability sampling to interview US adults. Per NHIS, telehealth utilization was defined as having had an appointment with a doctor, nurse, or other health professional by video or phone in the past 12 months. Individuals were asked whether they had ever 1) discussed the possibility of getting a genetic test for cancer risk with a doctor or other health care professionals and 2) had a genetic test to determine if they are at greater risk of developing cancer. We calculated weighted percentages and conducted Rao-Scott Chi-square tests, followed by weighted logistic regression, adjusting for sociodemographic characteristics and personal and family cancer history. All analyses accounted for survey weights. Results: We obtained an unweighted sample of 29,522 adults (weighted n = 258,237,552; mean age, 48.2 years). 11.8% were Black, 17.5% were Hispanic, and 61.9% were White; 51.2% were female. Overall, 26.7% (95% CI, 26.0-27.4%) used telehealth in the past 12 months; 7.6% (95% CI, 7.3-8.0%) had discussed cancer genetic testing, and 5.1% (95% CI, 4.8-5.4%) had genetic testing for cancer. Compared to telehealth non-users, users reported higher percentages of cancer genetic testing discussion (12.0% [95% CI, 11.1-12.8%] vs 6.0% [95% CI, 5.7-6.6%]) and uptake (10.2% [95% CI, 9.6-10.8%] vs 4.9% [4.5-5.3%]) (both p <0.001). After covariate adjustment, users remained at higher odds of having discussed cancer genetic testing (adjusted odds ratio [aOR], 1.68; 95% CI, 1.50-1.87) and having had a genetic test (aOR, 1.66; 95% CI, 1.47-1.89) than non-users. In addition, personal or family cancer history, older age, female sex, and higher levels of education were associated with higher odds of cancer genetic testing discussion and uptake. Conclusions: Telehealth presents a promising avenue for expanding access to discussions about cancer genetic testing as well as genetic testing. However, current implementation may drive existing disparities. Future work should focus on promoting telehealth to optimize equity in care delivery.

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