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Genetic Testing and Education: New Horizons
Episode

Sheetal Parmar, Vice President of Medical Affairs at Natera

Genetic Testing and Education: New Horizons

 

In this episode, we are honored to have Sheetal Parmar, who is here to chat about genetic counseling, something new to many of us and something other people may have heard about. Sheetal is a board-certified genetic counselor and the vice president of medical affairs at Natera. Natera is a global leader in cell-free (cfDNA) testing focusing on women’s health, oncology, and organ health. 

Sheetal shares with us that genetic counseling is the process of helping people understand and adapt to the medical, psychological, and family implications of genetic diseases and their contribution of genetic disease to their families. Also, what a genetic counselor is and how their skills are used across any medical field. She tells us how genetic counselors work throughout Natera in patient and health care provider management. Sheetal also dives deep into how beneficial genetic testing can be to understand one’s health. 

This episode is incredibly insightful regarding the many benefits of genetic testing and genetic counselors, tune in and enjoy!

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Genetic Testing and Education: New Horizons

About Sheetal Parmar

Ms. Parmar is a board-certified genetic counselor specializing in prenatal diagnosis and screening. Sheetal received her BA in Molecular and Cell Biology from UC Berkeley and her MS in Genetic Counseling from the University of Cincinnati. She joined Natera after working 11 years as the lead prenatal genetic counselor at a high-risk prenatal diagnosis clinic and cytogenetic laboratory. She has served on the Board of Directors and various committees for the National Society of Genetic Counselors (NSGC); and has a special interest in genetic counselor education, serving as an Advisory Board member for the California State Stanislaus genetic counseling training program as well as a site visitor for the Accreditation Council of Genetic Counseling (ACGC). Sheetal was the Director of Medical Education at Natera, most recently, responsible for the Medical Science Liaison team, Women’s Health Advisory programs, and NIPT product development. Sheetal travels across the US and internationally to provide clinical education on Natera’s products.

Genetic testing and education: new horizons with Sheetal Parmar, Vice President of Medical Affairs at Natera: Audio automatically transcribed by Sonix

Genetic testing and education: new horizons with Sheetal Parmar, Vice President of Medical Affairs at Natera: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.

Saul Marquez:
Hey Outcomes Rocket Nation! Saul Marquez here, I want to talk to you about Natera, a leader in personalized genetic testing and diagnostics that is transforming how we make critical health care decisions. Natera is revolutionizing the standard of medical care with next-generation cell-free DNA testing. Its non-invasive blood tests provide critical health insights to improve outcomes and enable earlier and more targeted interventions that lead to longer, healthier lives. Be sure to check out Natera to learn more. That’s Natera, NATERA.com to learn more.

Saul Marquez:
Hey everybody, welcome back to the Outcomes Rocket and welcome back to this super interesting series that we’re doing with Natera on genetic testing, everything genetic specifically around cell-free DNA testing, and what it means to improve outcomes. We had a phenomenal first two interviews with Dr. Billings, and today I’m really excited to dive into a topic that, maybe new for a lot of you, but maybe you might be familiar with it. Either way, I think it’s a great opportunity to level-set on, on the topic of genetic counseling, and here with me today is the outstanding Sheetal Parmar, she is the vice president of medical affairs at Natera. She’s also a board-certified genetic counselor specializing in prenatal diagnosis and screening. She joined Natera in 2013 after working for 11 years as the lead prenatal genetic counselor at a high-risk prenatal diagnosis clinic and cytogenetic laboratory. She received her bachelor’s in Molecular and Cell Biology from UC Berkeley and her master’s in Science in Genetic Counseling from the University of Cincinnati. Beyond her preparation, she is just, she’s done so much in this field and I’m so excited to have her share with us what is genetic counseling and what is a counselor and just dive into what it means to you and your practice, your business and overall your family and your health. So Sheetal, such a pleasure to have you here with us today.

Sheetal Parmar:
Thank you so much for inviting me, it’s a pleasure to be here.

Saul Marquez:
And so, you know, I think it’s so important in this field of genetic testing to really help people understand what it is that they’re doing, implications, impacts, so talk to us about what a genetic counselor is. Let’s start with the basics and help us go from there.

Sheetal Parmar:
Yeah, you sort of nailed it. If we start by talking about what genetic counseling is, it’s the process of helping people understand and adapt to the medical, psychological, and family implications of genetic diseases and the contribution of genetic disease to their families and genetic counselors, specifically, we have advanced training in medical genetics and counseling, so it’s a unique field and that we all have a master’s degree in either human genetics or genetic counseling, and we have specialized counseling skills, snd the idea is to guide and support patients and individuals seeking information about how genetic conditions may affect them or their families.

Saul Marquez:
Super interesting. It’s a very specialized field and it’s constantly changing. You know, one of the, one of the themes that came up in our discussions with Dr. Billings is this ever-changing landscape, and so I can imagine that this highly-specialized credential is important. Tell us about the team there and you lead the councelor team, tell us how many, tell us what you do, I would love to hear more about that.

Sheetal Parmar:
Sure. So in general, outside of Natera, just as sort of a basic just to level-set, you know, genetic counselors can work in a variety of settings. They can work in laboratories, which I can give you a little more information about what our team does, they also can work in academic centers and hospitals, some are in private practice and a wide variety of different areas of medicine. I did my work in prenatal, but folks can do oncology, pediatrics, cardiology, you name it, personalized medicine. And a lot of folks spend time, you know, explaining test options, procedures and results and educating patients and providers, and helping, emotionally support patients through their, through their testing process. And a lot of those, a lot of those skills are what are used at Natera. So Natera, we have, across the company, well over 70 genetic counselors that work in a variety of settings, so it’s a huge team. So we have folks that are working as, in sort of less traditional roles, I don’t know that there is a traditional role anymore for genetic counselors, but if you think of historically, we have some folks that provide education to health care providers in the field, we call that our medical science liaison team, most of in women’s health, all of them are genetic counselors. We also, folks throughout the company and product development and leadership, sales training in operations that are, you know, in clinical research that are genetic counselors by training that have moved into other areas of the business. Our largest group of genetic counselors, I think, it’s probably over 60 is the laboratory genetic counselor team, and that team speaks to patients and to health care providers. So for patients, we provide genetic information sessions either before testing or after testing for all of our panels of tests that we have available at Natera, so patients can have the opportunity to ask questions before they have testing and help with understanding their results, and understanding their follow steps after testing, so we do have that and that can be done sort of on-demand or patient calls in or by making an appointment online. We also speak to health care providers, so physicians and other ordering, test orders who may have questions about whether a patient is a good candidate for testing or they want just more information about the tests or, afterwards they need some assistance with test interpretation or next steps as well.

Saul Marquez:
Wow! It’s a, pretty in-depth and all-encompassing.

Sheetal Parmar:
Yes.

Saul Marquez:
Yeah. So it sounds like the lab counselors are likely maybe the most engaged in this onboarding and helping people on the back end of it?

Sheetal Parmar:
Yes, they’re the ones that are closest to the patients and helping them through their testing journey. So from the moment someone’s thinking about having a test all the way through when the test is completed and what to do next with their results.

Saul Marquez:
Very cool. So who could benefit the most out of receiving this type of counseling? You know, and keeping in mind, folks listening to us today are, you know, obviously themselves, their families, but they also run health care organizations, whether they’re a provider or a business executive, they’re in seats where they potentially could steer groups of people to do this. Can you tell us who could benefit from it?

Sheetal Parmar:
You know, anyone who is interested in genetic testing should have access to genetic counseling. We believe really strongly in that, that anyone who wants to understand what the benefits and the limitations of testing might be, what the best options are for them would benefit from genetic counseling. You know, a lot of folks may obtain genetic counseling from their primary health care provider, from their OB, from a genetic counselor elsewhere, and so a lot of pre-test does happen externally, but is also available through telemedicine service, through the laboratory and certainly any time someone has testing understanding what those results mean and again, understanding the limitations and what the next steps are, I think is absolutely critical. You know, a lot of, a lot of the genetic information services that we provide are in the post-test level. But certainly, I think anyone who is even considering testing may want to talk to a counselor, but a lot of times testing is done and then the individual wants to know what, what am I supposed to do with this now, right? And that’s where we really can provide that detailed level of information.

Saul Marquez:
Wow, that’s super interesting. And you know, as, as you think about the whole process, yeah, right, after you take a test like this, you’re likely to receive information, but how do you make that information actionable? And I imagine that that’s probably a big part of what you guys do.

Sheetal Parmar:
Yes, absolutely. People are having testing at different stages in their life. For example, someone may be choosing to have carrier screening in order to determine if they’re a carrier or at risk to pass on a genetic condition to their children as part of reproductive testing, right? And that could be done before you’re even thinking about getting pregnant or sometimes during the pregnancy. And so what the actions are based on that would be different based on where you are in that process. Same applies for hereditary cancer testing. If doing it as a screen to find out more information, maybe based on your family history or just your interest in knowing more information about your health versus actively having cancer and dealing with the results in the context of a diagnosis is going to have different implications. And so that’s part of the reason that genetic counseling is there is to put those pieces together and help the emotional aspects of those are different as well, right, depending on what, you know, where you are in your life stage, where you are and your health history, as to how you would interpret that, what you would do next, and I think genetic counselors are really one part of a larger health system, right? So we are part of that team to help make sure that you access the right resources afterwards as well. So not understanding, not just, to your point, understanding the results, but who are the other folks I need to talk to next with regard to this information?

Saul Marquez:
Yeah, Sheethal, and you know, I think you may have mentioned this before, is there an element of what you guys do as counselors to counsel the actual provider so the physician administering a test or prescribing it? Can you talk to that?

Sheetal Parmar:
Yes, yes! That’s a really critical part of what we do here to make sure that our tests are used appropriately and responsibly. So we provide a lot of resources to ordering health care providers to educate them at a basic level about genetics, if that is something they’re interested in and providing them with information about what each test is and how it should or could be used for different patients, how to identify the right patients who may be best suited for any individual test or panel, for example, and also providing resources to help them provide pre-test and post-test education, right? So when we think about genetic counseling, you may not realize this, a lot of folks don’t realize this, but there are probably only about fifty-five hundred, a little over fifty-five hundred genetic counselors in the entire country, in the US.

Saul Marquez:
Wow!

Sheetal Parmar:
And that’s one hundred percent increase from ten years ago!

Sheetal Parmar:
That’s crazy!

Sheetal Parmar:
But we’re very small field. And.

Saul Marquez:
Wow!

Sheetal Parmar:
And so we rely, you know, part of the genetic, what we do as genetic counselors and what’s really important for us at Natera is to make sure that we can provide the resources to ordering providers so that they also can provide genetic counseling and pre and post-test support to their patients. So we actually started a program called the Natera Academy, and the Natera Academy provides tools and resources that are minimally branded, so basically, just educational videos and tools and aids for counseling so that physicians and other ordering health care providers have the resources they need to offer testing and to discuss results afterwards with their patients. So we’ve made a really concerted effort to extend the reach of what we do to help health care providers decide what’s best for their patients and also support them. So we do, we do that. And then we have, like I mentioned, a medical science liaison team across all of our business units that support health care providers in the field so they can meet with physicians, they can do lectures, they can help onboard them so that they understand how the tests work and they’re available to them as well.

Saul Marquez:
That’s amazing. What a service. And you know, I’m just sitting here thinking about all of the people that could benefit from this, whether they’re physicians that are part of a large hospital chain or if they’re even standalone clinics, right? Offering primary care work, that could be so beneficial, so then is this a certification as well? They could get certified through Natera Academy?

Sheetal Parmar:
So it is, it is a program where, yeah, there are different levels of information that can be provided. We, we’d like to be able to, it’s not a, like an actual certification at this point, we actually have an idea to be able to do that eventually. So people feel like.

Saul Marquez:
That would be interesting.

Sheetal Parmar:
They’ve gone through the courses. Yeah, some of it was a little derailed with the pandemic, so we’ve done, we’re doing a lot of virtual training, but yeah, that is sort of the idea, is to hear different levels of information, here’s prenatal, here’s oncology, here’s renal disease, and be able to get providers the information resources they need.

Saul Marquez:
In itself, it sounds super useful. And I mean, if you’re, if you’re looking to use these types of tests in your practice or offering these things to your, the lives that you’re responsible for, certainly consider going to that Natera.com site and see all the stuff that she and her team are doing, just incredible. I mean, I’m just impressed at how much of a thought leader you guys are here and the work that you’re doing not only to educate but also to enable those that are choosing this path. So kudos to you and your team, Sheetal, on the awesome work that you’re doing here.

Sheetal Parmar:
Oh, thank you so much! Yeah, we, the team is really excited to be able to offer these types of testing to the community, health care providers, and patients, and we really want folks to make the best decisions for themselves and their families. So we want to have all the tools and people available to help with that.

Saul Marquez:
I love that. So there is a thing called a, I guess you guys call it genetic education extenders, can you talk to us about that and how this could help amplify the work that your counselors do?

Sheetal Parmar:
Yes. So our genetic counseling team and our MSL teams are able to provide that patient-level care and provider-level care, but we want folks to be able to access genetic education 24/7. So in addition to Natera Academy, in addition to the genetic information sessions that you can have with a board-certified counselor, we’ve developed a virtual assistant, also called the chatbot named Neva, Natera’s Educational Virtual Assistant, and Neva provides pre and post-test genetic education twenty-four hours a day, seven days a week, online. So our first use case for Neva, it’s been almost two years now, was providing post-test results for carrier screening, so you can get your results and get educated and even make an appointment with the genetic counselor directly in the tool. So we have that pre and post-test across a number of our products, and we’re adding more through time. So this allows patients to access their information and either pre or post-test whatever time suits them and makes the most sense for them, and we’ve done well over twenty thousand Neva sessions.

Saul Marquez:
Wow!

Sheetal Parmar:
Across our products. Yeah! And I would say about a third of the time they’re used outside of normal business hours. So we know this is what patients would like to have is access to their information at a time that’s convenient for them.

Saul Marquez:
Totally. Yeah, you’re working during the day. You just want to access it when you put the kids to bed, like ok, what am I going to do here, right? And it’s very real. So on one of those Neva sessions, how do you guys define or measure success? I’m just curious, you know, what is a successful Neva session look like?

Sheetal Parmar:
That’s a great question, and we want to make sure that, one, it’s engaging enough that someone finishes the session, right?

Saul Marquez:
Yeah.

Sheetal Parmar:
So we do check to see that and we do collect patient feedback to make sure, one, it needs to be understandable, right? It needs to make sense, it needs to be able to provide the information at a basic level so that a patient is not confused or worried, right? So if you’re getting information, a lot of people were concerned, you know, if you’re getting information from not a human, is that what kind of emotional reaction? And so we’ve been collecting data from patients on how they feel after a Neva session and the vast majority of patients, almost all, have reported Neva’s knowledgeable, friendly, supportive, and so that’s, that’s sort of how we measure our success. Is the patient actually getting what they need? And are they able to access additional resources right away, right? Like getting, speaking to a counselor the next day, for example, if they still have questions.

Saul Marquez:
That is super helpful. And yeah, I mean, it’s ,it’s just a great way to do it. So as we think through really, you know, availability of these things, oftentimes, in fact, probably most times and correct me if I’m, if I’m wrong here, but a lot of it comes through, all right, I went to my provider and they got me a prescription or they led me to this option, is there any of this happening,just coming from patients actually initiating the testing themselves?

Sheetal Parmar:
Yes. So there are some laboratories that have what we would kind of call patient-initiated testing where patients can obtain a physician-ordered test. So it’s not the same as direct to consumer, that’s a very different model, but a laboratory, such, a clear laboratory that is able to, a patient’s able to get pre-test education and then have the testing still ordered through a physician, but they initiate it themselves.

Saul Marquez:
Ok, got it.

Sheetal Parmar:
Yeah. And so that is available today through some laboratories. And it is one other way that I think is making genetic testing accessible to more people and not having to wait to go see a physician if they want to know what their carrier screen is for example, with their carrier screening status is, they can potentially request that themselves.

Saul Marquez:
Got it. So it’s available. But yet it’s not, it’s not a B2C thing. You still need to go through your provider. You still need to go through the right approach.

Sheetal Parmar:
Correct. So for this type of testing, it is not direct to consumer. In the same way, the laboratory testing still needs to be ordered by a physician and with appropriate consent.

Saul Marquez:
Got it. And so through all of this, right, I mean, we’re still dealing with the third year of COVID, and people still want to know how to get these things done. You know, we have deferred care for too long, and I think that health system leaders are realizing that, they have realized that, so we can’t do it, the wheel must continue to turn. Are you guys providing this type of counseling through tele-counseling and other ways?

Sheetal Parmar:
Yes, actually, we, our patient information sessions or genetic information sessions that I talked about earlier, those are a complimentary service that’s part of the testing protocol, and those are done by phone. We’ve been doing that for many years.

Saul Marquez:
Oh, okay.

Sheetal Parmar:
Yeah. And well, we have added to that, we’ve added additional service. So the pandemic really highlighted the need for more telemedicine. And I think almost everyone probably listening is engaged in some sort of telemedicine appointment at this point, and I don’t think that’s going away. I think, if anything, we found that that is actually a very beneficial way to obtain medical care. But we do have an additional arm of service called the Telehealth Genetic Counseling Service, which is a more billable genetic counseling service. So it’s not part of the genetic information sessions, this is a more comprehensive level of service that we have just started offering, and we’re really excited about so that more patients can have access to genetic counseling even if they live in remote areas, or they don’t have immediate access to an academic center or genetic counselor that’s local in their area. So that’s something that’s new for us, but we’re really excited to expand.

Saul Marquez:
That is really cool.

Sheetal Parmar:
Yeah.

Saul Marquez:
You know, as we think about improving access to these types of really transformative technologies, having something like a counseling as a service, whether it be counseling for patients or the actual providers is so important, especially given the numbers that you shared, right? There’s a few of you guys.

Sheetal Parmar:
Absolutely, yes. So it’s learning how to teach providers how to triage patients and be able to, yeah, from a telemedicine standpoint, you can serve so many more patients without having to be at a local area, so it actually does absolutely expand service and access to patients.

Saul Marquez:
Wow. Amazing. Well, Sheetal, you guys are doing incredible work, I want to, I could keep asking you stuff here and then keep you for an hour, but we can’t do that, unfortunately, but what I will do is invite you to give us a closing thought. And then the listeners, I’m sure, have more questions, want to explore more, let them know where they could do that. So why don’t we go ahead and do that? And then we’ll, we’ll say goodbye.

Sheetal Parmar:
Well, thank you so much for having me today. I think what’s most important for whether you’re a health care provider or you’re working in the hospital industry or your patient, we’re all patients in some way, you know, access to genetic counseling is important. I think as we move into more and more personalized medicine, everyone’s going to have DNA testing for whatever stage in life that you’re in. And we want to make sure that you know, you have access to a genetic counselor and so that you are best supported through your entire testing journey and for the Natera’s products and genetic counseling and genetic information services, they’re all available on our website, including access to making an appointment online.

Saul Marquez:
Awesome. And that is Natera.com. Sheetal, thank you so much, this has been so, so informational and really enjoyable, and I’m sure that the listeners are feeling the same way. So I want to give you a big thanks for you and the work that you and your team does for health care in our country.

Sheetal Parmar:
Thank you so much. It’s been a pleasure.

Saul Marquez:
A leader in personalized genetic testing, Natera combines its cell-free DNA platform with cutting-edge technology and a focus on real-world data to transform what’s possible during people’s most critical health moments. Natera has applied its core technology to the areas of women’s health, oncology, and organ health, helping millions of people manage their disease from a simple, non-invasive blood test. If you’re interested in learning more about how Natera is revolutionizing the standard of medical care, visit Natera.com That’s N A T E R A.com

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Things You’ll Learn

  • Genetic counselors are part of a more extensive health system.
  • Genetic testing can help you understand what conditions can be hereditary without even having that condition yourself. 
  • Genetic counseling is available not only to explain your test results but also to support the patients emotionally. 
  • Genetic counselors are helpful for patients but also for physicians and providers. 
  • Genetic testing is not available B2C now; if you want one, you will have to go through your provider. 

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