1
|
Espinoza Moya ME, Guertin JR, Dorval M, Lapointe J, Bouchard K, Nabi H, Laberge M. Examining interprofessional collaboration in oncogenetic service delivery models for hereditary cancers: a scoping review protocol. BMJ Open 2022; 12:e066802. [PMID: 36523215 PMCID: PMC9748975 DOI: 10.1136/bmjopen-2022-066802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION In a context of limited genetic specialists, collaborative models have been proposed to ensure timely access to high quality oncogenetic services for individuals with inherited cancer susceptibility. Yet, extensive variability in the terminology used and lack of a clear understanding of how interprofessional collaboration is operationalised and evaluated currently constrains the development of a robust evidence base on the value of different approaches used to optimise access to these services. To fill in this knowledge gap, this scoping review aims to systematically unpack the nature and extent of collaboration proposed by these interventions, and synthesise the evidence available on their implementation, effectiveness and economic impact. METHODS AND ANALYSIS Following the Joanna Briggs Institute guidelines for scoping reviews, a comprehensive literature search will be conducted to identify peer-reviewed and grey literature on collaborative models used for adult patients with, or at increased risk of, hereditary breast, ovarian, colorectal and prostate cancers. An initial search was developed for Medline, Embase, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Cochrane and Web of Science on 13 June 2022 and will be complemented by searches in Google and relevant websites. Documents describing either the theory of change, planning, implementation and/or evaluation of these interventions will be considered for inclusion. Results will be summarised descriptively and used to compare relevant model characteristics and synthesise evidence available on their implementation, effectiveness and economic impact. This process is expected to guide the development of a definition and typology of collaborative models in oncogenetics that could help strengthen the knowledge base on these interventions. Moreover, because we will be mapping the existing evidence on collaborative models in oncogenetics, the proposed review will help us identify areas where additional research might be needed. ETHICS AND DISSEMINATION This research does not require ethics approval. Results from this review will be disseminated through peer-reviewed articles and conferences.
Collapse
Affiliation(s)
- Maria Eugenia Espinoza Moya
- Population Health and Optimal Health Practices Unit, Centre de Recherche du Centre hospitalier universitaire (CHU) de Québec-Université Laval, Quebec City, Quebec, Canada
- Département des opérations et systèmes de décision, Faculté des sciences de l'administration, Université Laval, Quebec City, Quebec, Canada
| | - Jason Robert Guertin
- Population Health and Optimal Health Practices Unit, Centre de Recherche du Centre hospitalier universitaire (CHU) de Québec-Université Laval, Quebec City, Quebec, Canada
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
| | - Michel Dorval
- Oncology Division, Centre de Recherche du CHU de Québec-Université Laval, Quebec City, Quebec, Canada
- Faculty of Pharmacy, Université Laval, Quebec City, Quebec, Canada
- CISSS, Chaudière-Appalaches Research Center, Lévis, Québec, Canada
| | - Julie Lapointe
- Oncology Division, Centre de Recherche du CHU de Québec-Université Laval, Quebec City, Quebec, Canada
| | - Karine Bouchard
- Département de cancérologie, CHU de Québec-Université Laval, Quebec City, Quebec, Canada
| | - Hermann Nabi
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
- Oncology Division, Centre de Recherche du CHU de Québec-Université Laval, Quebec City, Quebec, Canada
| | - Maude Laberge
- Population Health and Optimal Health Practices Unit, Centre de Recherche du Centre hospitalier universitaire (CHU) de Québec-Université Laval, Quebec City, Quebec, Canada
- Département des opérations et systèmes de décision, Faculté des sciences de l'administration, Université Laval, Quebec City, Quebec, Canada
- Vitam, Centre de recherche en santé durable, Laval University, Quebec City, Quebec, Canada
| |
Collapse
|
2
|
Unim B, Pitini E, Lagerberg T, Adamo G, De Vito C, Marzuillo C, Villari P. Current Genetic Service Delivery Models for the Provision of Genetic Testing in Europe: A Systematic Review of the Literature. Front Genet 2019; 10:552. [PMID: 31275354 PMCID: PMC6593087 DOI: 10.3389/fgene.2019.00552] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 05/24/2019] [Indexed: 11/13/2022] Open
Abstract
Background: The provision of genetic services, along with research in the fields of genomics and genetics, has evolved in recent years to meet the increasing demand of consumers interested in prediction of genetic diseases and various inherited traits. The aim of this study is to evaluate genetic services in order to identify and classify delivery models for the provision of genetic testing in European and in extra-European countries. Methods: A systematic review of the literature was conducted using five electronic resources. Inclusion criteria were that studies be published in English or Italian during the period 2000-2015 and carried out in European or extra-European countries (Canada, USA, Australia, or New Zealand). Results: 148 genetic programs were identified in 117 articles and were delivered mostly in the UK (59, 40%), USA (35, 24%) or Australia (16, 11%). The programs were available nationally (66; 45%), regionally (49; 33%) or in urban areas (21, 14%). Ninety-six (64%) of the programs were integrated into healthcare systems, 48 (32.21%) were pilot programs and five (3%) were direct-to-consumer genetic services. The genetic tests offered were mainly for BRCA1/2 (59, 40%), Lynch syndrome (23, 16%), and newborn screening (18, 12%). Healthcare professionals with different backgrounds are increasingly engaged in the provision of genetic services. Based on which healthcare professionals have prominent roles in the respective patient care pathways, genetic programs were classified into five models: (i) the geneticists model; (ii) the primary care model; (iii) the medical specialist model; (iv) the population screening programs model; and (v) the direct-to-consumer model. Conclusions: New models of genetic service delivery are currently under development worldwide to address the increasing demand for accessible and affordable services. These models require the integration of genetics into all medical specialties, collaboration among different healthcare professionals, and the redistribution of professional roles. An appropriate model for genetic service provision in a specific setting should ideally be defined according to the type of healthcare system, the genetic test provided within a genetic program, and the cost-effectiveness of the intervention. Only applications with proven efficacy and cost-effectiveness should be implemented in healthcare systems and made available to all citizens.
Collapse
Affiliation(s)
- Brigid Unim
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Erica Pitini
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | | | - Giovanna Adamo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Corrado De Vito
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Carolina Marzuillo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Paolo Villari
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| |
Collapse
|
3
|
Benjamin CM, Thomas LH, Skirton H, Gustafson S, Coupe J, Patch C, Belk R, Tishkovskaya S, Calzone K, Payne K. Interventions to improve patient access to and utilisation of genetic and genomic counselling services. Cochrane Database Syst Rev 2015; 2015:CD011873. [PMID: 26989348 PMCID: PMC4790801 DOI: 10.1002/14651858.cd011873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
This is the protocol for a review and there is no abstract. The objectives are as follows. PRIMARY OBJECTIVE The primary objective is to assess the effectiveness of interventions to improve patient identification, access to and utilisation of genetic and genomic counselling services when compared to: No intervention;Usual or current practice; andOther active intervention. SECONDARY OBJECTIVE The secondary objective is to explore the resource use and costs associated with interventions aimed at improving patient identification, access to and utilisation of genetic and genomic counselling services from studies meeting the eligibility criteria. We will report on factors that may explain variation in the effectiveness of interventions aimed at improving patient identification, access to and utilisation of genetic and genomic counselling services from studies meeting the eligibility criteria. Another secondary objective is to explore how interventions which target improved patient identification, access to and utilisation of genetic and genomic counselling services affect the subsequent appropriate use of health services for the prevention or early detection of disease. It is also possible that the genetic counselling interaction itself will contribute to the possible use of preventative services.
Collapse
Affiliation(s)
- Caroline M Benjamin
- School of Health, University of Central Lancashire, Preston, UK
- Department of Clinical Genetics, Liverpool Women’s NHS Foundation Trust, Liverpool, UK
| | - Lois H Thomas
- School of Health, University of Central Lancashire, Preston, UK
| | - Heather Skirton
- Faculty of Health and Human Sciences, University of Plymouth, Plymouth, UK
| | | | | | - Christine Patch
- Department of Clinical Genetics, Guys and St Thomas’ NHS Foundation Trust, London, UK
| | - Rachel Belk
- Manchester Centre for Genomic Medicine, St Mary’s Hospital, Manchester, UK
| | | | - Kathleen Calzone
- Centre for Cancer Research, Genetics Branch, National Cancer Institute, Bethesda, Maryland, USA
| | - Katherine Payne
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
| |
Collapse
|
4
|
Trepanier AM, Allain DC. Models of service delivery for cancer genetic risk assessment and counseling. J Genet Couns 2013; 23:239-53. [PMID: 24158360 DOI: 10.1007/s10897-013-9655-6] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 08/30/2013] [Indexed: 10/26/2022]
Abstract
Increasing awareness of and the potentially concomitant increasing demand for cancer genetic services is driving the need to explore more efficient models of service delivery. The aims of this study were to determine which service delivery models are most commonly used by genetic counselors, assess how often they are used, compare the efficiency of each model as well as impact on access to services, and investigate the perceived benefits and barriers of each. Full members of the NSGC Familial Cancer Special Interest Group who subscribe to its listserv were invited to participate in a web-based survey. Eligible respondents were asked which of ten defined service delivery models they use and specific questions related to aspects of model use. One-hundred ninety-two of the approximately 450 members of the listserv responded (42.7%); 177 (92.2%) had provided clinical service in the last year and were eligible to complete all sections of the survey. The four direct care models most commonly used were the (traditional) face-to-face pre- and post-test model (92.2%), the face-to-face pretest without face-to-face post-test model (86.5%), the post-test counseling only for complex results model (36.2%), and the post test counseling for all results model (18.3%). Those using the face-to-face pretest only, post-test all, and post-test complex models reported seeing more new patients than when they used the traditional model and these differences were statistically significantly. There were no significant differences in appointment wait times or distances traveled by patients when comparing use of the traditional model to the other three models. Respondents recognize that a benefit of using alternative service delivery models is increased access to services; however, some are concerned that this may affect quality of care.
Collapse
Affiliation(s)
- Angela M Trepanier
- Center for Molecular Medicine and Genetics, Wayne State University, 540 E. Canfield Street, 2375 Scott Hall, Detroit, MI, 48201, USA,
| | | |
Collapse
|
5
|
Lockett A, Currie G, Waring J, Finn R, Martin G. The role of institutional entrepreneurs in reforming healthcare. Soc Sci Med 2012; 74:356-363. [DOI: 10.1016/j.socscimed.2011.02.031] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2010] [Revised: 11/11/2010] [Accepted: 02/13/2011] [Indexed: 11/27/2022]
|
6
|
Battista R, Blancquaert I, Laberge AM, van Schendel N, Leduc N. Genetics in Health Care: An Overview of Current and Emerging Models. Public Health Genomics 2012; 15:34-45. [DOI: 10.1159/000328846] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2010] [Accepted: 04/18/2011] [Indexed: 11/19/2022] Open
|
7
|
Unleashing the power of human genetic variation knowledge: New Zealand stakeholder perspectives. Genet Med 2011; 13:26-38. [PMID: 21068671 DOI: 10.1097/gim.0b013e3181f9648a] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE This study aimed to characterize the challenges in using genetic information in health care and to identify opportunities for improvement. METHODS Taking a grounded theory approach, semistructured interviews were conducted with 48 participants to collect multiple stakeholder perspectives on genetic services in New Zealand. RESULTS Three themes emerged from the data: (1) four service delivery models were identified in operation, including both those expected models involving genetic counselors and variations that do not route through the formal genetic service program; (2) multiple barriers to sharing and using genetic information were perceived, including technological, organizational, institutional, legal, ethical, and social issues; and (3) impediments to wider use of genetic testing technology, including variable understanding of genetic test utilities among clinicians and the limited capacity of clinical genetic services. Targeting these problems, information technologies and knowledge management tools have the potential to support key tasks in genetic services delivery, improve knowledge processes, and enhance knowledge networks. CONCLUSION Because of the effect of issues in genetic information and knowledge management, the potential of human genetic variation knowledge to enhance health care delivery has been put on a "leash."
Collapse
|
8
|
Lillie AK, Clifford C, Metcalfe A. Caring for families with a family history of cancer: why concerns about genetic predisposition are missing from the palliative agenda. Palliat Med 2011; 25:117-24. [PMID: 21228091 DOI: 10.1177/0269216310383738] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Care of the family is integral to palliative care, but little attention has been paid to the way nurses, or other healthcare professionals, are responding to the needs of families who are concerned about whether their family history of cancer is associated with an inherited genetic predisposition. This paper discusses how palliative care nurses perceive the care needs of patients with a family history of cancer. Data were collected through recorded, semi-structured interviews with 10 nurses who had worked in specialist palliative care. The findings show that there are cogent arguments and concerns about raising the issue of an inherited genetic predisposition at the end of life (especially when the patient is close to death and there is a lack of knowledge about genetics). Nevertheless, exemplar cases are used to illustrate the reasons why it is important that nurses working in specialist palliative care settings are aware of the needs of this patient group. The paper highlights that nurses not only need an appropriate knowledge base but also an insight of what can be achieved when supporting patients with a family history of cancer.
Collapse
|
9
|
Martin GP. The third sector, user involvement and public service reform: a case study in the co-governance of health service provision. PUBLIC ADMINISTRATION 2011; 89:909-932. [PMID: 22165150 DOI: 10.1111/j.1467-9299.2011.01910.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The ‘modernization’ of British public services seeks to broaden public sector governance networks, bringing the views of third sector organizations, the public and service users (among others) to the design, management and delivery of welfare. Building on previous analyses of the contradictions generated by these roles, this paper draws on longitudinal qualitative research to enunciate the challenges faced by one third-sector organization in facilitating service user influence in a UK National Health Service (NHS) pilot programme, alongside other roles in tension with this advocacy function. The analysis highlights limits in the extent to which lateral governance networks pluralize stakeholder involvement. The ‘framing’ of governance may mean that traditional concerns outweigh the views of new stakeholders such as the third sector and service users. Rather than prioritizing wider stakeholders' views in the design and delivery of public services, placing third sector organizations at the centre of governance networks may do more to co-opt these organizations in reproducing predominant priorities.
Collapse
|
10
|
Bennett CL, Burke SE, Burton H, Farndon PA. A toolkit for incorporating genetics into mainstream medical services: Learning from service development pilots in England. BMC Health Serv Res 2010; 10:125. [PMID: 20470377 PMCID: PMC2887834 DOI: 10.1186/1472-6963-10-125] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2009] [Accepted: 05/14/2010] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND As advances in genetics are becoming increasingly relevant to mainstream healthcare, a major challenge is to ensure that these are integrated appropriately into mainstream medical services. In 2003, the Department of Health for England announced the availability of start-up funding for ten 'Mainstreaming Genetics' pilot services to develop models to achieve this. METHODS Multiple methods were used to explore the pilots' experiences of incorporating genetics which might inform the development of new services in the future. A workshop with project staff, an email questionnaire, interviews and a thematic analysis of pilot final reports were carried out. RESULTS Seven themes relating to the integration of genetics into mainstream medical services were identified: planning services to incorporate genetics; the involvement of genetics departments; the establishment of roles incorporating genetic activities; identifying and involving stakeholders; the challenges of working across specialty boundaries; working with multiple healthcare organisations; and the importance of cultural awareness of genetic conditions. Pilots found that the planning phase often included the need to raise awareness of genetic conditions and services and that early consideration of organisational issues such as clinic location was essential. The formal involvement of genetics departments was crucial to success; benefits included provision of clinical and educational support for staff in new roles. Recruitment and retention for new roles outside usual career pathways sometimes proved difficult. Differences in specialties' working practices and working with multiple healthcare organisations also brought challenges such as the 'genetic approach' of working with families, incompatible record systems and different approaches to health professionals' autonomous practice. 'Practice points' have been collated into a Toolkit which includes resources from the pilots, including job descriptions and clinical tools. These can be customised for reuse by other services. CONCLUSIONS Healthcare services need to translate advances in genetics into benefits for patients. Consideration of the issues presented here when incorporating genetics into mainstream medical services will help ensure that new service developments build on the body of experience gained by the pilots, to provide high quality services for patients with or at risk of genetic conditions.
Collapse
Affiliation(s)
- Catherine L Bennett
- NHS National Genetics Education and Development Centre, Birmingham Women's NHS Foundation Trust, Edgbaston, Birmingham, B15 2TG, UK
| | - Sarah E Burke
- School of Education, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Hilary Burton
- PHG Foundation, Strangeways Research Laboratory, Worts Causeway, Cambridge, CB1 8RN, UK
| | - Peter A Farndon
- NHS National Genetics Education and Development Centre, Birmingham Women's NHS Foundation Trust, Edgbaston, Birmingham, B15 2TG, UK
| |
Collapse
|
11
|
Martin G, Currie G, Finn R. Bringing genetics into primary care: Findings from a national evaluation of pilots in England. J Health Serv Res Policy 2009; 14:204-11. [DOI: 10.1258/jhsrp.2009.008158] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objectives: Developments in genetic knowledge and clinical applications are seen as rendering traditional modes of organizing genetics provision increasingly inappropriate. In common with a number of developed world countries the UK has sought to increase the role of primary care in delivering such services. However, efforts to reconfigure service delivery face multiple challenges associated with divergent policy objectives, organizational boundaries and professional cultures. This paper presents findings from an evaluation of an English initiative to integrate genetics into ‘mainstream’ clinical provision in the National Health Service. Methods: Qualitative research in 11 case-study sites focusing on attempts by pilots funded by the initiative to embed knowledge and provision within primary care illustrating barriers faced and the ways in which these were surmounted. Results: Lack of intrinsic interest in clinical genetics among primary care staff was compounded by national targets that focused their attention elsewhere and by service structures that rendered genetics a peripheral concern demanding minimal engagement. Established divisions between the commissioning of mainstream and specialist services, along with the pressures of shorter-term targets, impeded ongoing funding. Conclusions: More wide-ranging policy and organizational support is required if the aim of entrenching genetics knowledge and practice across the Health Service is to be realized.
Collapse
|
12
|
Integrating genetic risk assessment for multi-factorial conditions into primary care. Prim Health Care Res Dev 2009. [DOI: 10.1017/s1463423609001200] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
|
13
|
Peters JA, Beckjord EB, Banda Ryan DR, Carr AG, Vadaparampil ST, Loud JT, Korde L, Greene MH. Testicular cancer and genetics knowledge among familial testicular cancer family members. J Genet Couns 2008; 17:351-64. [PMID: 18481162 PMCID: PMC3111072 DOI: 10.1007/s10897-008-9153-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2007] [Accepted: 02/18/2008] [Indexed: 11/27/2022]
Abstract
PURPOSE It was our aim to determine baseline levels of testicular cancer and genetics knowledge among members of families with Familial Testicular Cancer (FTC). METHODS This is a sub-study of an ongoing National Cancer Institute (NCI) multidisciplinary, etiologically-focused, cross-sectional study of FTC. We evaluated 258 male and female participants including testicular cancer (TC) survivors, blood relatives and spouses to assess factors associated with a Genetic Knowledge Scale (GKS) and Testicular Cancer Knowledge Scale (TCKS). RESULTS Knowledge levels were generally low, with genetic knowledge lower than TC knowledge (p < 0.01). Men with a personal TC history scored highest on TC knowledge, while gender, age and education differentially influenced knowledge levels, particularly among unaffected relatives. CONCLUSIONS Prior to identifying FTC susceptibility genes, we recommend tailoring FTC genetic education to the different informational needs of TC survivors, their spouses and relatives, in preparation for the day when clinical susceptibility testing may be available.
Collapse
Affiliation(s)
- June A Peters
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, 6120 Executive Blvd., EPS 7026, Rockville, MD 20852, USA.
| | | | | | | | | | | | | | | |
Collapse
|