Home›Genetics & Precision Medicine› eREACH digital intervention meets non-inferiority for genetic service uptake and anxiety in cancer patients
eREACH digital intervention meets non-inferiority for genetic service uptake and anxiety in cancer patientsDigital tools may offer an alternative to genetic counselor counseling
medRxivPublished September 8, 2026Study authors: Lee, K. T.; Egleston, B.; Fetzer, D.; Domchek, S. M.; Fleisher, L.; Wen, K.-Y.; Wagner, L.; Roberts,…DOI ↗Editorial oversight: Dr. Julia Lee, PhD · Oncology, Genomics & Drug Development
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Key Takeaway
Consider eREACH as a non-inferior alternative to counselor counseling for pre-test genetic counseling and uptake.
This randomized non-inferiority trial enrolled 773 patients with and without cancer who met criteria for genetic testing. The study compared the eREACH intervention, a patient-centered digital intervention, against traditional genetic counselor (GC) counseling using a 4-arm design (GC/GC, GC/digital, digital/GC, and digital/digital).
The primary outcomes included uptake of genetic services, changes in genetic knowledge, and changes in general anxiety from baseline to post-disclosure. The eREACH intervention met non-inferiority for both uptake of genetic services and general anxiety. Of the participants, 584 (76%) completed testing. However, the results for changes in genetic knowledge were inconclusive.
Secondary outcomes included cognitive outcomes, affective outcomes, satisfaction, and MICRA scores. For patients with positive or VUS results via digital disclosure, MICRA scores were significantly higher, indicating a greater negative response. Safety data, including adverse events and tolerability, were not reported.
A key limitation of the study is the inconclusive data regarding knowledge gains. Clinically, the eREACH intervention was effective for pre-test counseling, while digital disclosure of results remains inconclusive. Digital delivery may be a reasonable alternative for individuals receiving negative results.
How this fits prior evidence
How this fits prior evidence: This finding addresses a gap in digital delivery methods for cancer patients. While previous evidence showed digital CBTi reduces insomnia severity scores more than telephone or group delivery methods, this study specifically evaluates the eREACH digital intervention for genetic counseling. It confirms that digital platforms can successfully facilitate pre-test counseling and service uptake, though it highlights specific risks in digital disclosure for certain results.
Navigating the world of genetic testing can be overwhelming. Patients often face complex information and heavy emotions before they even receive their results. A nationwide study looked at whether a digital tool, called eREACH, could work just as well as a human genetic counselor to prepare patients for these tests.
The study followed 773 people who were eligible for genetic testing. The researchers found that the digital tool was not inferior to human counseling when it came to getting patients ready for testing. It also performed just as well in helping patients manage their general anxiety before they received their results.
However, the results were a bit more mixed when it came to how much patients actually learned about genetics through the digital tool. Also, patients who received positive or uncertain results through a digital platform reported higher scores on a scale measuring negative emotional responses. While the digital tool is a practical option for some, the results for knowledge were inconclusive.
What this means for you:
Digital tools can be a comparable alternative to human counselors for preparing patients for genetic testing.
Common questions
Is a digital tool as good as a human counselor for genetic testing?
The study found that the eREACH digital intervention was not inferior to human genetic counselor counseling. It worked well for pre-test counseling and was just as effective at managing general anxiety before patients received their results.
Does the digital tool help patients learn more about their genetics?
The results for whether patients gained more knowledge about genetics through the digital tool were inconclusive. While it helped with preparation and anxiety, it did not clearly show a superior way to increase a patient's specific genetic knowledge.
Are there any risks to using a digital tool for results?
Patients who received positive or uncertain results through a digital disclosure had significantly higher MICRA scores, which indicates a greater negative emotional response. You should talk to your doctor about which delivery method is best for your specific situation.
Background: Many at-risk patients lack access to genetic services due to a genetic counselor (GC) workforce shortage. Little is known about how digital alternatives impact patients with and without cancer who meet criteria for genetic testing. Methods: eREACH2 is a randomized 4-arm non-inferiority trial where pre-test (visit 1) and/or return of results (visit 2) GC counseling was replaced with a patient-centered digital intervention. Arms include: A (GC/GC), B (GC/digital), C (digital/GC) and D (digital/digital). Primary outcomes were non-inferiority in uptake of genetic services and change in genetic knowledge and general anxiety from baseline to post-disclosure of results (T0-T2). Secondary cognitive and affective outcomes were assessed using non-inferiority ANOVAs and equivalency chi-squared tests in intention-to-treat and per-protocol analyses. Findings: 773 participants were recruited nationwide; 46.6% from rural areas. Mean age was 51 years (range 20-87), 13% male, 12% non-white, 29% had less than a college education, and 33% had a personal history of cancer. 584 (76%) patients completed testing (14% had a positive result, 16% had a VUS). In the primary ITT analyses, we met the non-inferiority for uptake of genetic services and anxiety, but results were inconclusive for knowledge. Secondary outcomes were heterogeneous across arms. Arm C demonstrated consistently favorable effects, while Arms B and D showed less favorable outcomes in select domains (e.g. satisfaction and MICRA). Patients who received positive or VUS results via digital disclosure had significantly higher MICRA scores - indicating greater negative response to testing. Interpretation: In this large, randomized trial of patients with and without cancer, the eREACH intervention was effective for pre-test counseling, but inconclusive for digital disclosure of results. Exploratory analyses suggest that digital delivery could be a reasonable alternative for individuals receiving negative results, while those receiving positive or VUS results may derive some short-term psychosocial benefit from GC disclosure.
