Original Article

Diagnostic Genetics
Ann Lab Med 2024;44:82-91
https://doi.org/10.3343/alm.2024.44.1.82
ISSN 2234-3806 • eISSN 2234-3814

Evaluation of Group Genetic Counseling Sessions via

a Metaverse-based Application
Boeun Yoo , M.S.1,2,*, Arang Kim , M.S.1,3,*, Hye Sung Moon , M.S.2, Min-Kyung So , M.D., Ph.D.1,4,
Tae-Dong Jeong , M.D., Ph.D.1,5, Kyoung Eun Lee , M.D., Ph.D.6, Byung-In Moon , M.D., Ph.D.2,7, and
Jungwon Huh , M.D., Ph.D.1,4
1
Department of Genetic Counseling, College of Medicine Graduate School, Ewha Womans University, Seoul, Korea; 2Cancer Center for Women, Ewha
Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Korea; 3Department of Pediatrics Molecular Genetics, Columbia
University Medical Center, New York, NY, USA; 4Department of Laboratory Medicine, Ewha Womans University Mokdong Hospital, Ewha Womans University
College of Medicine, Seoul, Korea; 5Department of Laboratory Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University College of
Medicine, Seoul, Korea; 6Department of Hematology and Oncology, Ewha Womans University Mokdong Hospital, Ewha Womans University College of
Medicine, Seoul, Korea; 7Department of Surgery, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Korea

Background: Group genetic counseling has been implemented to meet growing demand. Received: March 24, 2023
Revision received: May 26, 2023
A metaverse platform, in which a society is built and activities are carried out in the virtual
Accepted: August 7, 2023
world, has not yet been implemented in group genetic counseling. We investigated whether
a metaverse platform could be an alternative service-delivery model for group genetic Corresponding author:
Jungwon Huh, M.D., Ph.D.
counseling. Department of Laboratory Medicine,
Methods: Participants (N=131) were divided into three groups: patient (N=45), family (N= Ewha Womans University College of
Medicine, 1071 Anyangcheon-ro,
43), and interested (N = 43) groups. Participants entered the metaverse through a link Yangcheon-gu, Seoul 07985, Korea
sent to their mobile phones and attended a 20-min group genetic counseling session re- E-mail: JungWonH@ewha.ac.kr
viewing hereditary breast cancer, followed by a 10-min question-and-answer period.
*These authors contributed equally to this
Results: The overall median score of post-educational knowledge (9.0, range 8.0–10.0) study as co-first authors.
significantly increased compared to that of pre-educational knowledge (6.0, range 3.0–
8.0) (P < 0.001). There was no significant difference in the pre- and post-educational
knowledge scores among the three groups (P > 0.05). Most participants (95%) responded
that their understanding of hereditary breast cancer had increased after the group genetic
counseling session and that their satisfaction was high. The main advantage noted with
metaverse was no limit of space and location while attending the session (97%), and the
main disadvantage was a possibility of missing content due to an unstable internet con-
nection (67%).
Conclusions: The metaverse platform would be acceptable as an alternative group genetic
counseling service. More studies are needed to investigate how, for whom, and in what cir- © Korean Society for Laboratory Medicine
This is an Open Access article distributed under
cumstances metaverse can be effectively utilized. the terms of the Creative Commons Attribution
Non-Commercial License (https://creativecom-
mons.org/licenses/by-nc/4.0) which permits
Key Words: Education, Genetic counseling, Group genetic counseling, Hereditary breast unrestricted non-commercial use, distribution,
and reproduction in any medium, provided the
cancer, Metaverse original work is properly cited.

INTRODUCTION their families to understand a disease and allow clinicians to

make informed decisions based on their situation.
Genetic counseling is an important process for patients and Although the importance of genetic counseling is well under-

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Group genetic counseling session via metaverse
stood among healthcare professionals in Korea, this service is
not readily available. Some barriers include genetic counselors
not being recognized as healthcare professionals under the Na-
tional Health Insurance system, the limited length of a genetic
counseling session per patient, and a lack of awareness of the
service. Every country has adapted genetic counseling services
to different healthcare systems. As the need for genetic counsel-
ing increases, healthcare providers in each country should con-
sider effective ways of providing genetic counseling to their own
populations.
Korea has a National Health Insurance system, and under Ko-
rean medical law, medical doctors and nurses are recognized as
medical professionals who can provide genetic counseling. Doc-
tors are required to see many patients within a limited time (e.g.,
30–60 patients in a 3–4-hr clinic), which means that doctors
can only spend 4–6 mins with each patient.
In this type of healthcare setting, traditional genetic counsel-
ing sessions that require 30–60 mins of counseling per patient
cannot be implemented well. Therefore, new methods of genetic
counseling should be considered and designed based on this
need.
Genetic counseling is typically conducted in one-on-one ses-
sions, which is crucial to maintain patient privacy and to protect
personal health information. However, general explanations of
genes, chromosomes, inheritance, genetic testing methods,
possible test results, and familial implications discussed during
the session do not necessarily include private information. In
healthcare systems with a limited number of genetic counselors
or healthcare professionals who can provide genetic counseling,
implementing group genetic counseling could be beneficial not
only to save time and resources but also to serve more patients
in need.
A metaverse is a space in which a society is built and activities
are carried out in the virtual world. Metaverse has been imple-
mented in medical education. For example, using a smart cam-
era built into the operating room, the surgical procedures were
livestreamed in the metaverse for medical students to observe
and learn [1]. In the last few years, there has been a movement
toward implementing the metaverse in digital healthcare. Stud-
ies have discussed the effectiveness of using a metaverse plat-
form in occupational therapy or mental health with virtual reality
(VR) or augmented reality (AR) [2-4]. In Korea, several hospitals
have opened clinics in this virtual world to provide various ser-
vices such as health consultations and patient education [5, 6].
Metaverse is already a hot topic in the healthcare industry;
however, no studies have examined the effectiveness and use-
https://doi.org/10.3343/alm.2024.44.1.82
fulness of its implementation in genetic counseling. We evalu-
ated whether the metaverse platform can be an alternative ser-
vice-delivery model for group genetic counseling to supplement
time and labor limitations. We investigated these issues while
providing group genetic counseling for patients, families, and/or
people with indications for counseling related to hereditary
breast cancer.
MATERIALS AND METHODS
Study design
Group genetic counseling for hereditary breast cancer was pro-
vided on the metaverse platform ifland from May 7, 2023, to
May 31, 2023. Prior to the session, the participants were asked
to complete a questionnaire to collect basic characteristics
(Supplemental Material 1) and a hereditary breast cancer
knowledge assessment questionnaire (Supplemental Material 2)
comprising 10 questions about hereditary breast cancer. After
the session, the participants were asked to complete the same
questionnaire to evaluate whether the session was effective in
improving their knowledge. A satisfaction survey (Supplemental
Material 3) was conducted to measure participants’ experi-
ences.
This study was conducted according to the ethical standards
of the Institutional Bioethics Committee of Mokdong Hospital af-
filiated with Ewha Womans University College of Medicine,
Seoul, Korea, and approved by the same Committee (No. 2022-
02-003-003).
Participants
Participants were recruited from Ewha Womans University, Col-
lege of Medicine, Mokdong Hospital (Seoul, Korea) between
April 15, 2022, and May 31, 2022. Recruitment posters were
posted at the hospital, and study participation was voluntary. At
the beginning of the study, 140 people expressed their intention
to participate, but nine did not participate in the scheduled ses-
sion (6.4% rejection rate).
The remaining 131 participants were divided into three groups:
a patient group (N = 45; patients who had been diagnosed as
having breast or ovarian cancer), a family group (N = 43; individu-
als who had never been diagnosed as having cancer but had a
family history of cancer), and an interested group (N = 43; indi-
viduals, including nurses, who were interested in learning about
hereditary breast cancer). All participants were Korean.
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Metaverse platform
The metaverse platform developed by SK Telecom ifland
(https://ifland.io/) was used in this study; ifland is download-
able only to people with Korean accounts.
Study procedures
Group genetic counseling session via ifland
The researcher provided a manual to the study participants re-
garding how to access the group genetic counseling session in
ifland and asked them to select the date of participation be-
tween May 7, 2022, and May 31, 2022. Each session was re-
peated 20 times.
The study participants were required to download the app on
their smartphones, create an ID, and set an avatar to partici-
pate. Each session was conducted in private mode, and only
those with a link provided by the researcher were able to access
the virtual conference room. As only avatars were used, none of
the participants’ personal health information was revealed. The
virtual conference room used for group genetic counseling is
presented in Supplemental Data Fig. S1.
In each session, a minimum of two and a maximum of 12 par-
ticipants participated. When the participants entered the virtual
conference room, they could move their avatar to a spot where
they wanted to sit and watch a video recorded by the researcher.
The video included topics such as the definition and characteris-
tics of hereditary breast cancer, types of available genetic tests,
interpretation of genetic testing, and the importance of genetic
testing and counseling (Supplemental Data Table S1). The ses-
sion lasted 30 mins, including watching the video for 20 mins
and a subsequent question-and-answer round for 10 mins. Par-
ticipants were encouraged to ask questions using a microphone
on the metaverse platform. The same two individuals facilitated
every group of genetic counseling sessions and answered ques-
tions: one was a doctor with a specialty in genetics and the
other was a nurse who obtained a Master’s degree from the
Graduate School of Genetic Counseling.
After the session, the participants were asked to come up to
the stage to take a group photo. The participants were able to
pose and dance as they desired.
Questionnaire and evaluation
The knowledge questionnaire (Supplemental Material 2) was a
revised form of the Breast Cancer Genetic Counseling Knowl-
edge Questionnaire developed by Erblich, et al . [7]. A total of 10
questions were included; correct answers were scored as “1”
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and incorrect or “I don’t know” answers were scored as “0.”
Another questionnaire (Supplemental Material 3) was used to
investigate participants’ satisfaction with the content of the
video, use of the metaverse platform, and advantages and dis-
advantages of using this new method of education. Each ques-
tion was evaluated on a 5-point scale: 5 for “strongly agree,” 4
for “agree,” 3 for “neutral,” 2 for “disagree,” and 1 for “strongly
disagree.”
Data analysis
The collected data were analyzed using SPSS Statistics (version
28.0, IBM, Chicago, IL, USA), and the differences in the general
characteristics of each study group were analyzed using the chi-
square test. The Kruskal–Wallis test was used to determine
whether there was a difference in knowledge among the study
groups. The Wilcoxon rank-sum test was used to analyze the dif-
ferences in knowledge scores before and after the genetic coun-
seling sessions in each study group. P < 0.05 was considered to
indicate a significant difference.
RESULTS
Participant characteristics
The participant characteristics are summarized in Table 1. Sig-
nificant differences were found among the three study groups in
terms of age (P = 0.017), sex (P = 0.001), marital status (P =
0.002), having children (P = 0.001), educational background
(P = 0.008), genetic testing (P = 0.001), and genetic counseling
(P = 0.001).
In the patient group, more than half of the participants were
in their 40s (51.1%), whereas the age group with the highest
representation in the family and interested groups was the 30s
(44.2% for both). In the patient group, 86.7% of the participants
had children, 55.6% had undergone genetic testing, and 44.4%
had undergone genetic counseling, which were the highest pro-
portions for these categories among the three study groups.
There were no male participants in the patient group, whereas
23.3% and 2.3% of the family and interested group participants
were male, respectively. The percentage of married individuals
was 73.3% overall, which was the highest in the patient group
(91.1%). Approximately four-fifths of the participants were col-
lege graduates (80.2%), and this proportion was the highest in
the interested group (93.0%). One of the reasons for the higher
education in the interested group was that 55.8% (24/43) of the
participants in this group were nurses. In the patient group, the
majority of participants had breast cancer (97.8%, 44/45) and
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Table 1. Characteristics of study participants

Total Patient group Family group Interested group
Variable P*
(N=131), N (%) (N=45), N (%) (N=43), N (%) (N=43), N (%)
Age, yrs 0.017
20–29 12 (9.2) 1 (2.2) 6 (14.0) 5 (11.6)
30–39 46 (35.1) 8 (17.8) 19 (44.2) 19 (44.2)
40–49 45 (34.4) 23 (51.1) 11 (25.6) 11 (25.6)
50–59 21 (16.0) 10 (22.2) 4 (9.3) 7 (16.3)
60–69 7 (5.3) 3 (6.7) 3 (7.0) 1 (2.3)
Sex 0.001
Male 11 (8.4) 0 (0.0) 10 (23.3) 1 (2.3)
Female 120 (91.6) 45 (100) 33 (76.7) 42 (97.7)
Marital status 0.002
Single 35 (26.7) 4 (8.9) 18 (41.9) 13 (30.2)
Married 96 (73.3) 41 (91.1) 25 (58.1) 30 (69.8)
Children 0.001
Yes 87 (66.4) 39 (86.7) 21 (48.8) 27 (62.8)
No 44 (33.6) 6 (13.3) 22 (51.2) 16 (37.2)
Education 0.008
High school certificate or equivalent 26 (19.8) 15 (33.3) 8 (18.6) 3 (7.0)
College graduate and above 105 (80.2) 30 (66.7) 35 (81.4) 40 (93.0)
Cancer history Not applicable
Breast cancer 44 (33.6) 44 (97.8) 0 (0.0) 0 (0.0)
Ovarian cancer 1 (0.8) 1 (2.2) 0 (0.0) 0 (0.0)
Unaffected 86 (65.6) 0 (0.0) 43 (100) 43 (100)
Family† history of cancer‡ 0.001
0 59 (45.0) 16 (35.6) 0 (0.0) 43 (100)
1 individual 43 (32.8) 15 (33.3) 28 (65.1) 0 (0.0)
2 individuals 13 (9.9) 7 (15.6) 6 (14.0) 0 (0.0)
≥3 individuals 16 (12.3) 7 (15.6) 9 (20.9) 0 (0.0)
Sources of cancer information §
Not applicable
Internet 94 (71.8) 39 (86.7) 30 (69.8) 25 (58.1)
Television/radio 12 (9.2) 5 (11.1) 5 (11.6) 2 (4.7)
Friends 17 (13.0) 3 (6.7) 9 (20.9) 5 (11.6)
Books 20 (15.3) 3 (6.7) 7 (16.3) 10 (23.3)
Patients 6 (4.6) 5 (11.1) 1 (2.3) 0 (0.0)
Family 1 (0.8) 0 (0.0) 1 (2.3) 0 (0.0)
Genetic testing use 0.001
Yes 30 (22.9) 25 (55.6) 5 (11.6) 0 (0.0)
No 101 (77.1) 20 (44.4) 38 (88.4) 43 (100)
(Continued to the next page)

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Table 1. Continued
Total Patient group Family group Interested group
Variable P*
(N=131), N (%) (N=45), N (%) (N=43), N (%) (N=43), N (%)
Type of genetic test (N=30) Not applicable
BRCA 24 (80.0) 21 (84.0) 3 (60.0) 0 (0.0)
Unknown 6 (20.0) 4 (16.0) 2 (40.0) 0 (0.0)
Genetic counseling experience 0.001
Yes 23 (17.6) 20 (44.4) 2 (4.7) 1 (2.3)
No 108 (82.4) 25 (55.6) 41 (95.3) 42 (97.7)
Heard of metaverse 0.160
Yes 84 (64.1) 29 (64.4) 31 (72.1) 24 (55.8)
No 47 (38.9) 16 (35.9) 12 (27.9) 19 (44.2)
Metaverse use experience 0.149
Yes 13 (9.9) 2 (4.4) 8 (18.6) 3 (7.0)
No 118 (90.1) 43 (95.6) 35 (81.4) 40 (93.0)
*Chi-square test.
†
Family: 3rd degree relative.
‡
Cancer: breast/ovarian cancer or other cancers (prostate, pancreatic, biliary tract, and melanoma).
§
Multiple responses possible.

one participant had ovarian cancer (2.2%); 64.5% of partici-
pants in the patient group had a family history of cancer in more
than one family member.
More participants in the family group had already heard about
the metaverse than those in the other two groups; however, the
difference was not significant (P = 0.16). In addition, 18.6% of
participants in the family group had previously used a metaverse
platform; this value was higher than the proportions in the other
two groups (4.4% and 7.0% in the patient and interested groups,
respectively), but the difference was not significant (P = 0.149).
In the patient group, 25 participants met the genetic testing
indications of the Korean National guidelines (ovarian cancer,
breast cancer diagnosed at or before the age of 40 yrs, breast
cancer, triple-negative breast cancer, breast cancer with ovarian
cancer or pancreatic cancer, breast cancer with one or more rel-
atives having breast cancer, ovarian cancer, male breast cancer,
metastatic prostate cancer, pancreatic cancer, etc.). In the fam-
ily group, five participants required genetic testing because they
carried a known pathogenic variant associated with hereditary
cancer in the family or had three or more family members with a
history of cancer. The interested group included only partici-
pants who did not have cancer themselves or in their families.
Knowledge evaluations before and after group genetic
counseling
Comparison of knowledge among study groups
We compared the study groups to determine whether there were
differences in knowledge before and after group genetic coun-
seling. The median knowledge score before the group genetic
counseling was higher in the interested group (7.0; interquartile
range [Q1–Q3] = 4.5–9.0) than in the patient (5.0; Q1–Q3 =
3.0–8.0) and family (5.0; Q1–Q3 = 3.0–7.0) groups, but the dif-
ference was not statistically significant (P = 0.130). There was also
no significant difference in knowledge level after genetic counsel-
ing education, with a median value of 9.0 (Q1–Q3 = 8.0–10.0) in
all three groups (P = 0.887).
Comparison of knowledge before and after group genetic
counseling in each study group
For all groups, the median pre-genetic counseling knowledge
score was 6.0 (Q1–Q3 = 3.0–8.0) and the median post-genetic
counseling knowledge score was 9.0 (Q1–Q3 = 8.0–10.0), rep-
resenting a statistically significant difference (P < 0.001). All
groups showed a significant increase in knowledge score after
the group genetic counseling session (P < 0.001; Table 2).
The complete results of the comparison of knowledge accord-
ing to each question before and after group genetic counseling

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Table 2. Comparison of knowledge scores before and after the group genetic counseling in each study group
Study group Pre-group genetic counseling, median (Q1–Q3)
Total 6.0 (3.0–8.0)
Patient group 5.0 (3.0–8.0)
Family group 5.0 (3.0–7.0)
Interested group 7.0 (4.0–9.0)
Abbreviations: Q1, first quartile; Q3, third quartile.
are presented in Supplemental Data Fig. S2.
Participants’ experiences of group genetic counseling in
the metaverse
In the evaluation of the educational video content, 93.2% of the
participants stated that it was easy to understand (answered
“strongly agree” or “agree”). Regarding the adequacy of the edu-
cational video length, sound, and screen quality, 95.1% of par-
ticipants responded that it was appropriate. In addition, 95.4%
of the participants answered that their level of understanding of
hereditary breast cancer improved after the metaverse-based
education session (Fig. 1).
Among all participants, 87.8% answered that the metaverse
session was more effective than face-to-face sessions (“strongly
agree” or “agree”), while 1.5% answered that it was not as effec-
tive. In addition, 93.1% of participants stated that they would
recommend group genetic counseling using the metaverse plat-
form to family members or acquaintances, and 92.4% of the
participants stated that they would want to participate in other
educational sessions using a metaverse platform in the future.
The advantages and disadvantages of the metaverse were
evaluated using multiple-choice questions (Table 3). The major-
ity of the participants stated “Can participate regardless of loca-
tion” (96.9%) and “Time can be used efficiently” (76.3%) as ad-
vantages of the metaverse-based session. The main disadvan-
tages stated were that it is “Possible to miss some content if the
internet connection is unstable” (67.2%) and that “Maintaining
concentration throughout the session is difficult” (27.5%).
DISCUSSION
To the best of our knowledge, this is the first study to examine
the possibility of an alternative service-delivery model for group
genetic counseling via the metaverse. The participants’ knowl-
edge level increased significantly after the group genetic coun-
seling session, and the participants were satisfied with the pro-
gram. Overall, our results show that group genetic counseling
https://doi.org/10.3343/alm.2024.44.1.82
Pre-group genetic counseling, median (Q1–Q3) Z P
9.0 (8.0–10.0) −9.026 <0.001
9.0 (8.0–10.0) −5.374 <0.001
9.0 (8.0–10.0) −5.393 <0.001
9.0 (8.0–10.0) −4.824 <0.001
via the metaverse is an acceptable alternative service-delivery
model.
Many healthcare providers are now familiar with telemedicine,
which utilizes telephone or video formats, because its use has
increased significantly since the coronavirus disease pandemic
[8-10]. Studies have examined the effectiveness of telegenetic
counseling. Danylchuk, et al . [11] provided a systematic review
of patients’ and providers’ experiences and access to telehealth
services. They concluded that telegenetic counseling is as effec-
tive as in-person counseling despite some limitations. For one-
on-one counseling, telegenetic counseling using Zoom, Google
Meet, or any other format could be helpful, as it provides an en-
vironment similar to that of in-person sessions. However, these
formats may be less effective for group genetic counseling. Be-
cause protecting patient privacy while providing a sense of par-
ticipation is important in a group setting, the metaverse can pro-
vide these factors by asking participants to use an avatar. The
metaverse could be more effective in certain groups of people
such as younger generations, including teenagers, as they are
more interested in and prone to accepting new technologies. In-
forming patients about certain genetic conditions, reviewing pre-
symptomatic genetic testing options based on their family his-
tory, or receiving assent for genetic testing using metaverse
methods could increase their interest and understanding. De-
spite some limitations, the study participants were highly satis-
fied with the metaverse platform, and we believe that it could be
considered for widespread utilization in the field of genetic
counseling and medicine.
Group genetic counseling may only be effective under certain
circumstances. An educational portion of genetic counseling
with general information can be provided to a group. This can in-
crease the efficiency of limited time and medical resources [12].
Recent studies have discussed the effectiveness of group ge-
netic counseling when addressing this educational information
to patients in a group setting [13, 14]. Hynes, et al . [14] con-
cluded that pre-test group genetic counseling with a short indi-
vidual session in patients with cancers was effective and that
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Group genetic counseling educational video content was

Length, sound and the quality of video were adequate
easy to understand
75.6% 80.6%
68.9% 77.8%
5 79.1% 5 86.0%
79.1% 79.1%
17.6% 14.5%
20.0% 13.3%
4 18.6% 4 1.4%
14.0% 16.3%
Score

Score
4.6% 3.1%
4.4% 6.7%
3 2.3% 3 0%
7.0% 2.3%
1.5% 1.5%
4.4% 2.2%
2 0% 2 0%
0% 2.3%
0.8% Total Family group 0% Total Family group
2.2% 0%
1 0% Patient group Interested group 1 0% Patient group Interested group
0% 0%

0 20 40 60 80 100 0 20 40 60 80 100
Satisfaction (%) Satisfaction (%)

After watching the educational video, my understanding of

hereditary breast cancer improved Metaverse felt more effective than face-to-face session

80.9% 58.0%
68.9% 53.3%
5 76.7% 5 58.1%
79.1% 62.8%
14.5% 29.8%
20.0% 26.7%
4 23.3% 4 34.9%
18.6% 27.9%
Score

Score

3.1% 10.7%
4.4% 15.6%
3 0% 3 7.0%
2.3% 9.3%
2.3% 1.5%
6.7% 4.4%
2 0% 2 0%
0% 0%
0% Total Family group 0%
Total Family group
0%
1 0% Patient group Interested group 1 0%
0%
Patient group Interested group
0%

0 20 40 60 80 100 0 20 40 60 80 100
Satisfaction (%) Satisfaction (%)

Want to recommend this group genetic counseling using Want to participate in other educational sessions using
the metaverse to family members or acquaintance the metaverse in the future
58.0% 71.8%
53.3% 71.1%
5 58.1% 5 74.4%
62.8% 69.8%
29.8% 20.6%
26.7% 17.8%
4 34.9% 4 23.3%
27.9% 20.9%
Score

Score

10.7% 5.3%
15.6% 4.4%
3 7.0% 3 2.3%
9.3% 9.3%
1.5% 1.5%
4.4% 4.4%
2 0% 2 0%
0% 0%
0% Total Family group 0.8% Total Family group
0% 2.2%
1 0% Patient group Interested group 1 0% Patient group Interested group
0% 0%

0 20 40 60 80 100 0 20 40 60 80 100
Satisfaction (%) Satisfaction (%)

Fig. 1. Results of the group genetic counseling satisfaction survey.

both the participating patients and genetic counselors were sat-
isfied with the new method. Cloutier, et al . [13] compared group
and individual genetic counseling sessions in women with a
positive prenatal screening result. They found that both meth-
ods resulted in high satisfaction in terms of patient care and
concluded that group genetic counseling with brief individual
sessions was effective.
Lohn, et al . [12] suggested that one of the strengths of group
genetic counseling is that by sharing the questions and answers
of other patients, each patient could explore related information.
We expected that there would be many questions during the
question-and-answer sessions in our study, as the avatar in the

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Table 3. Evaluation of the participants’ experiences of the metaverse-based group genetic counseling
Total Patient group Family group Interested group
Question
(N=131), N (%) (N=45), N (%) (N=43), N (%) (N=43), N (%)
Advantages
Can participate regardless of location 127 (96.9) 43 (91.5) 43 (100) 41 (95.3)
Time can be used efficiently 100 (76.3) 37 (78.7) 31 (72.1) 32 (74.4)
Participation can be repeated 34 (26.0) 7 (14.9) 17 (39.5) 10 (23.3)
Asking questions and receiving answers are easy 33 (25.2) 11 (23.4) 11 (25.6) 11 (25.6)
Can meet people with same interest within the virtual space and communicate easily 54 (41.2) 19 (40.4) 19 (44.2) 16 (37.2)
Participating is enjoyable 59 (45.0) 17 (36.2) 22 (51.2) 20 (46.5)
Others* 4 (3.1) 0 (0.0) 2 (4.7) 2 (4.7)
Disadvantages
Using the metaverse is burdensome and difficult 11 (8.4) 2 (4.4) 3 (7.0) 6 (14.0)
Maintaining concentration throughout the session is difficult 36 (27.5) 8 (17.8) 17 (39.5) 11 (25.6)
The contents are not delivered clearly 9 (6.9) 3 (6.7) 5 (11.6) 1 (2.3)
Questions and answers are less effective 11 (8.4) 6 (13.3) 4 (9.3) 1 (2.3)
Possible to miss some content if the internet connection is unstable 88 (67.2) 29 (64.4) 30 (69.8) 29 (67.4)
The new platform is unfamiliar 23 (17.6) 12 (6.7) 4 (9.3) 7 (16.3)
None 2 (1.5) 1 (2.2) 0 (0.0) 1 (2.3)
Others† 3 (2.3) 0 (0.0) 0 (0.0) 3 (7.0)
*“It was fun and interesting,” “It was nice to participate privately,” “I was able to communicate and relieve stress by meeting people,” and “I was able to par-
ticipate comfortably.”
†
“It was awkward because it was my first time using it” and “Older people who have difficulty in accessing the internet could have a harder time using it.”

metaverse could make people feel more comfortable talking;
however, only three of 131 participants asked questions. This
could simply reflect a general cultural characteristic of Koreans
being averse to asking questions in front of people or it may
have reflected that the participants felt uncomfortable asking
questions related to their personal health in a public forum. Ko-
reans are known to be more active in asking questions in the
form of writing such as in a chat window than out loud by voice.
Encouraging asking questions in the chat window of the meta-
verse may be helpful in increasing interaction and complement-
ing the characteristics of Koreans who are not comfortable with
direct questions. We believe that private sessions after group
genetic counseling will be beneficial for participants who want to
ask questions more specific to their personal history, as sug-
gested previously [13, 14]. Cloutier, et al . [13] stated that 86%
of participants attended an individual session after group ge-
netic counseling was performed. This indicates that there is in-
formation that cannot be fully covered by group genetic counsel-
ing and that people are eager for more information. As tailoring
the session based on the patient’s medical and family histories
is necessary for genetic counseling, providing individual genetic
counseling after the group session would be helpful. Additional
customized one-on-one genetic counseling sessions can be con-
ducted in the personal space of the metaverse platform or
through in-person visits for effective genetic counseling.
Another factor to consider with group genetic counseling is
that it may provide emotional/psychosocial support to patients
in similar disease groups. Spiers, et al . [15] conducted a qualita-
tive study on group genetic counseling in patients testing posi-
tive for Huntington’s disease (HD) (predictive testing). They used
a narrative group exercise facilitated by both a clinical psycholo-
gist and genetic counselor and found that participants were able
to connect and provide “peer support” to each other, which gave
them a positive outlook in living with an HD diagnosis.
Finally, the content of group genetic counseling should be de-
veloped based on the understanding and needs of the target
audience. This sounds very basic; however, it is important to re-
member. As a healthcare professional, one invests many years
to become an expert and this knowledge may become natural,
resulting in skipping the longer process of decision-making
through following an algorithm in favor of coming to a quick con-
clusion. However, as a genetic counseling session can be the

https://doi.org/10.3343/alm.2024.44.1.82 www.annlabmed.org  89

first time that patients and families are learning about the rele-
vant contents provided, a more comprehensive explanation may
be required. This is important because the patients are ulti-
mately those making important decision related to their health.
It is not easy to meet the informational needs of all individu-
als, as people’s educational backgrounds, life experiences, and
matters of interest are all different. If there is a way to evaluate
people’s understanding after each group’s genetic counseling
session, genetic counselors will be able to develop more specific
private sessions, even if people might not want to be evaluated.
Future studies could be conducted with modified group genetic
counseling sessions based on our findings to re-evaluate partici-
pants’ understanding. In addition, comparing the understanding
of people who received only group genetic counseling to that of
people who received both group genetic counseling and private
sessions would be interesting.
A limitation of this study was that we were not able to com-
pare the effectiveness of group genetic counseling using the
metaverse with other methods/platforms such as in-person
meetings or telehealth platforms (e.g., Zoom and Google Meet).
Peshkin, et al . [16] compared telephone and in-person genetic
counseling and concluded that non-traditional methods were vi-
able options in that they maintained similar levels of patient
knowledge and satisfaction as found for the traditional method.
This indicates that other platforms can be expected to be effec-
tive. Buchanan, et al . [17] and Greenberg, et al . [18] mentioned
that alternative service-delivery models are becoming more im-
portant. In the future, it would be interesting to compare the ef-
fectiveness of all the platforms currently available to determine
if all methods could offer the same level of understanding,
which could be helpful to improve access to genetic counseling
and the quality of patient care.
In conclusion, genetic counseling via the metaverse platform
is an acceptable alternative service for group genetic counsel-
ing. As this is the first study utilizing the metaverse for telege-
netic counseling, more studies will be needed to ensure that
this platform is applied constructively in current practice.
SUPPLEMENTARY MATERIALS
Supplementary materials can be found via https://doi.
org/10.3343/alm.2024.44.1.82
ACKNOWLEDGEMENTS
None.
90  www.annlabmed.org
Yoo B, et al.
Group genetic counseling session via metaverse
AUTHOR CONTRIBUTIONS
Huh J and Kim A contributed to the study organization, design,
and supervision. Kim A and Yoo B drafted the manuscript. Yoo B
and Moon H were involved in data collection. So M, Jeong T, Lee
K, Moon B, and Huh J were involved in data interpretation. All
the authors have read and approved the final manuscript.
CONFLICTS OF INTEREST
None declared.
RESEARCH FUNDING
None declared.
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