Author ORCID Identifier


Date of Graduation


Document Type

Thesis (MS)

Program Affiliation

Genetic Counseling

Degree Name

Masters of Science (MS)

Advisor/Committee Chair

Maureen Mork, MS, CGC

Committee Member

Myla Ashfaq, MS, CGC

Committee Member

S. Shahrukh Hashmi, MD, PhD

Committee Member

Eduardo Vilar Sanchez, MD, PhD

Committee Member

Autumn Vara, MS, CGC


There are a multitude of barriers known to impact access to medical care in the United States. COVID-19 has changed and compounded these barriers and led to a shift in the setting of the genetic counseling (GC) appointment, and in sample types used for genetic testing, specifically with use of telemedicine and remotely collected saliva kits. Previous studies have described lack of patient follow-through in returning these kits. Though the understanding of barriers to medical care, including access to genetics services, is well described, there is little in the literature for how these barriers impact the return of remotely collected saliva kits for genetic testing. This retrospective chart review of two hospital systems in Houston, Texas, one a specialty hospital and one a safety-net hospital, obtained personal and familial health, demographic, and socioeconomic information on 326 individuals who consented to hereditary cancer genetic testing and were sent a saliva collection kit for remote sample collection. The overall rate of saliva kit return was 84.3%. Non-White patients were less likely to return saliva kits at both hospital systems, and patients with higher measure of socioeconomic disadvantage were less likely to return their kits at the safety-net hospital. These results are consistent with previously reported barriers to health and genetics care. However, other variables associated with common barriers to medical care, or personal factors associated with genetic testing motivation, were not found to be statistically significant. Patient loss to follow-up for genetic testing may be inherent to remote sample collection, beyond what is associated with known barriers to genetics care. GCs can use this information to modify how they discuss remote sample collection with their patients. Gauging patient interest about what type of sample collection may work best for them and advocating for a blood draw instead of a remotely collected sample when feasible could improve the rates of return for remote collection kits, and therefore increase the number of patients receiving genetic results that may impact care for themselves and their families.


genetics, genetic testing, hereditary cancer, covid, covid-19, genetic counseling, socioecenomic, disparities



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