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Søby AKH, Andersen CM, Bille C, Larsen BF, Heidemann LN, Johansen RA, Timm H, Roessler KK. What do women at high risk of breast cancer request of a patient education day? Focus interviews with women before and after deciding about prophylactic interventions. Eur J Cancer Care (Engl) 2022; 31:e13588. [PMID: 35396775 PMCID: PMC9539475 DOI: 10.1111/ecc.13588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 02/12/2022] [Accepted: 03/28/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE At a Danish Hospital, we wished to establish a co-designed patient education day about prophylactic interventions for women at high risk of developing breast cancer. However, knowledge is lacking on the women's acceptability and requests for content. The objective of this study is to gain knowledge about the acceptability and requests of the content of a patient education day among women at high risk of breast cancer considering prophylactic mastectomy. METHODS A user panel consisting of patients and health care professionals developed an interview guide for two focus interviews with two groups of women at high risk of breast cancer; one group had received a prophylactic mastectomy and one group considered it. Thematic analysis was used to explore the participants' acceptability and requests for content. RESULTS Meaningful content was knowledge about prophylactic interventions, how to share knowledge with partners and children, and talking to equals in a safe forum. Not all participants wished to discuss own surgery in a group setting. CONCLUSION An education day is an acceptable and supportive format for gaining knowledge about surgery, but since some topics may be vulnerable to discuss in a group setting to some women, we suggest the education day as a valuable supplement to the individual consultations.
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Affiliation(s)
| | | | - Camilla Bille
- Department of Plastic SurgeryOdense University HospitalOdenseDenmark
| | | | | | | | - Helle Timm
- National Institute of Public HealthUniversity of Southern DenmarkOdenseDenmark
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Lohn Z, Fok A, Richardson M, Derocher H, Mung SW, Nuk J, Yuson J, Jevon M, A Schrader K, Sun S. Large-scale group genetic counseling: Evaluation of a novel service delivery model in a Canadian hereditary cancer clinic. J Genet Couns 2021; 31:459-469. [PMID: 34596310 DOI: 10.1002/jgc4.1512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 09/01/2021] [Accepted: 09/04/2021] [Indexed: 11/12/2022]
Abstract
Increasing demand for genetic services has led to the development of streamlined genetic counseling (GC) models. We piloted large-scale group pre-test GC with up to 50 patients per group and compared this to a traditional one-on-one approach. Patients referred to the British Columbia (BC) Cancer Hereditary Cancer Program were eligible if they had: (a) family history meeting our program's referral criteria; (b) no relevant personal history of cancer; (c) no prior genetic testing in the family; and (d) no living testable relative in BC. Patient-reported outcome measures included: (a) Genetic Counselling Outcome Scale (GCOS) prior to pre-test GC (T1) and at 4 weeks post-test GC (T2); (b) Satisfaction Survey after pre-test GC; and (c) the Multidimensional Impact of Cancer Risk Assessment (MICRA) for patients undergoing testing (4 weeks after post-test GC). In total, 391 patients underwent GC, 184 by group and 207 by one-on-one appointments. Between May 2018 and May 2019, 6 pre-test group sessions were conducted (median number of patients per group = 28; range 15-48). 8% of patients (n = 32) declined large group GC due to personal preference for one-on-one GC. There were no statistically significant differences in MICRA and GCOS survey results when comparing the pre-test large group versus traditional pre-test one-on-one models (based on 3 MICRA subscales: p = 0.063, p = 0.612, p = 0.842; and GCOS p = 0.169). Overall, the large group pre-test counseling approach was more time-efficient with 15-48 patient group sessions conducted over a mean duration of 80 min as compared to 42 min per patient with the traditional one-on-one GC model. Large-scale group GC was feasible and acceptable to patients and represents a novel streamlined model for GC to enable timely access to cancer genetic services.
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Affiliation(s)
- Zoe Lohn
- Hereditary Cancer Program, BC Cancer, Vancouver, BC, Canada
| | - Alexandra Fok
- Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, BC, Canada
| | - Matthew Richardson
- Department of Interdisciplinary Oncology, The University of British Columbia, Vancouver, BC, Canada
| | | | - Sze Wing Mung
- Hereditary Cancer Program, BC Cancer, Vancouver, BC, Canada
| | - Jennifer Nuk
- Hereditary Cancer Program, BC Cancer, Vancouver, BC, Canada
| | - Jamie Yuson
- Hereditary Cancer Program, BC Cancer, Vancouver, BC, Canada
| | - Mandy Jevon
- Hereditary Cancer Program, BC Cancer, Vancouver, BC, Canada
| | - Kasmintan A Schrader
- Hereditary Cancer Program, BC Cancer, Vancouver, BC, Canada.,Department of Molecular Oncology, BC Cancer, Vancouver, BC, Canada.,Department of Medical Genetics, The University of British Columbia, Vancouver, BC, Canada
| | - Sophie Sun
- Hereditary Cancer Program, BC Cancer, Vancouver, BC, Canada.,Division of Medical Oncology, The University of British Columbia, Vancouver, BC, Canada
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Cremin C, Lee MK, Hong Q, Hoeschen C, Mackenzie A, Dixon K, McCullum M, Nuk J, Kalloger S, Karasinska J, Scudamore C, Kim PTW, Donnellan F, Lam ECS, Lim HJ, Neben CL, Stedden W, Zhou AY, Schaeffer DF, Sun S, Renouf DJ, Schrader KA. Burden of hereditary cancer susceptibility in unselected patients with pancreatic ductal adenocarcinoma referred for germline screening. Cancer Med 2020; 9:4004-4013. [PMID: 32255556 PMCID: PMC7286471 DOI: 10.1002/cam4.2973] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 02/17/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Recent guidelines recommend consideration of germline testing for all newly diagnosed pancreatic ductal adenocarcinoma (PDAC). The primary aim of this study was to determine the burden of hereditary cancer susceptibility in PDAC. A secondary aim was to compare genetic testing uptake rates across different modes of genetic counselling. PATIENTS AND METHODS All patients diagnosed with PDAC in the province of British Columbia, Canada referred to a population-based hereditary cancer program were eligible for multi-gene panel testing, irrespective of cancer family history. Any healthcare provider or patients themselves could refer. RESULTS A total of 305 patients with PDAC were referred between July 2016 and January 2019. Two hundred thirty-five patients attended a consultation and 177 completed index germline genetic testing. 25/177 (14.1%) of unrelated patients had a pathogenic variant (PV); 19/25 PV were in known PDAC susceptibility genes with cancer screening or risk-reduction implications. PDAC was significantly associated with PV in ATM (OR, 7.73; 95% CI, 3.10 to 19.33, P = 6.14E-05) when comparing age and gender and ethnicity-matched controls tested on the same platform. The overall uptake rate for index testing was 59.2% and was significantly higher with 1-on-1 consultations and group consultations compared to telehealth consultations (88.9% vs 82.9% vs 61.8%, P < .001). CONCLUSION In a prospective clinic-based cohort of patients with PDAC referred for testing irrespective of family history, germline PV were detected in 14.1%. PV in ATM accounted for half of all PVs and were significantly associated with PDAC. These findings support recent guidelines and will guide future service planning in this population.
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Affiliation(s)
- Carol Cremin
- Hereditary Cancer ProgramBC Cancer, part of Provincial Health Services AuthorityVancouverBCCanada
- Pancreas Centre BCVancouverBCCanada
| | - Michael Kuan‐Ching Lee
- Pancreas Centre BCVancouverBCCanada
- Division of Medical OncologyBC Cancer, part of Provincial Health Services AuthorityVancouverBCCanada
| | - Quan Hong
- Hereditary Cancer ProgramBC Cancer, part of Provincial Health Services AuthorityVancouverBCCanada
| | - Carolyn Hoeschen
- Pancreas Centre BCVancouverBCCanada
- Division of Medical OncologyBC Cancer, part of Provincial Health Services AuthorityVancouverBCCanada
| | - Anna Mackenzie
- Hereditary Cancer ProgramBC Cancer, part of Provincial Health Services AuthorityVancouverBCCanada
| | - Katherine Dixon
- Department of Medical GeneticsUniversity of British ColumbiaVancouverBCCanada
| | - Mary McCullum
- Hereditary Cancer ProgramBC Cancer, part of Provincial Health Services AuthorityVancouverBCCanada
| | - Jennifer Nuk
- Hereditary Cancer ProgramBC Cancer, part of Provincial Health Services AuthorityVancouverBCCanada
| | - Steve Kalloger
- Pancreas Centre BCVancouverBCCanada
- Department of Pathology & Laboratory MedicineVancouver General HospitalVancouverBCCanada
| | | | - Charles Scudamore
- Pancreas Centre BCVancouverBCCanada
- Department of SurgeryVancouver General HospitalVancouverBCCanada
| | - Peter T. W. Kim
- Pancreas Centre BCVancouverBCCanada
- Department of SurgeryVancouver General HospitalVancouverBCCanada
| | - Fergal Donnellan
- Pancreas Centre BCVancouverBCCanada
- Department of GastroenterologyVancouver General HospitalVancouverBCCanada
| | - Eric C. S. Lam
- Pancreas Centre BCVancouverBCCanada
- Department of GastroenterologySt. Paul's HospitalVancouverBCCanada
| | - Howard J. Lim
- Pancreas Centre BCVancouverBCCanada
- Division of Medical OncologyBC Cancer, part of Provincial Health Services AuthorityVancouverBCCanada
| | | | | | | | - David F. Schaeffer
- Pancreas Centre BCVancouverBCCanada
- Department of Pathology & Laboratory MedicineVancouver General HospitalVancouverBCCanada
| | - Sophie Sun
- Hereditary Cancer ProgramBC Cancer, part of Provincial Health Services AuthorityVancouverBCCanada
- Division of Medical OncologyBC Cancer, part of Provincial Health Services AuthorityVancouverBCCanada
| | - Daniel J. Renouf
- Pancreas Centre BCVancouverBCCanada
- Division of Medical OncologyBC Cancer, part of Provincial Health Services AuthorityVancouverBCCanada
| | - Kasmintan A. Schrader
- Hereditary Cancer ProgramBC Cancer, part of Provincial Health Services AuthorityVancouverBCCanada
- Pancreas Centre BCVancouverBCCanada
- Department of Medical GeneticsUniversity of British ColumbiaVancouverBCCanada
- Department of Molecular Oncology, BC Cancerpart of Provincial Health Services AuthorityVancouverBCCanada
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Hynes J, MacMillan A, Fernandez S, Jacob K, Carter S, Predham S, Etchegary H, Dawson L. Group plus "mini" individual pre-test genetic counselling sessions for hereditary cancer shorten provider time and improve patient satisfaction. Hered Cancer Clin Pract 2020; 18:3. [PMID: 32099586 PMCID: PMC7029530 DOI: 10.1186/s13053-020-0136-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 01/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Genetic counselling (GC) is an integral component in the care of individuals at risk for hereditary cancer predisposition syndromes (CPS). In many jurisdictions, access to timely counselling and testing is limited by financial constraints, by the shortage of genetics professionals and by labor-intensive traditional models of individual pre and post-test counselling. There is a need for further research regarding alternate methods of GC service delivery and implementation. This quality improvement project was initiated to determine if pretest group GC followed immediately by a 'mini' individual session, would be acceptable to patients at risk for hereditary breast and colon cancer. METHODS Patients on waitlists for GC at the Provincial Medical Genetics Program in St. John's, NL, Canada (n = 112), were contacted by telephone and offered the option of a group counselling session (GGC), followed by a "mini" individual session, versus (TGC) traditional private appointments. GGC sessions consisted of a cancer genetics information session given to groups of 6-20 followed by brief 20 min "mini" individual sessions with the patient and genetic specialist. TGC individual appointments provided the same cancer genetics information and counselling to one patient at a time in the classic model. All but 2 participants selected group+mini session. A de-identified confidential 12-item, Likert scale survey was distributed at the conclusion of mini-sessions to measure perceptions of GGC and satisfaction with this counselling model. RESULTS Sixty participants completed questionnaires. The majority of participants strongly agreed that they were comfortable with the group session (58/60); the explanation of cancer genetics was clear (54/59); they understood their cancer risks (50/60); and they would recommend such a session to others (56/59). 38/53 respondents disagreed or strongly disagreed that they would prefer to wait for a traditional private appointment. All 5 participating genetic counselors reported a preference for this model. At the end of the pilot project, the waitlist for counselling/testing was reduced by 12 months. CONCLUSIONS Group pre-test genetic counselling combined with immediate "mini" individual session is strongly supported by patients and reduces wait times. Additional formal investigation of this approach in larger numbers of patients is warranted.
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Affiliation(s)
- Jaclyn Hynes
- Clinical Epidemiology, Faculty of Medicine, Memorial University, St. John’s, Newfoundland and Labrador Canada
| | - Andrée MacMillan
- Provincial Medical Genetics Program, Health Sciences Centre, Eastern Health Authority, St. John’s, Newfoundland and Labrador Canada
| | - Sara Fernandez
- Provincial Medical Genetics Program, Health Sciences Centre, Eastern Health Authority, St. John’s, Newfoundland and Labrador Canada
| | - Karen Jacob
- Provincial Medical Genetics Program, Health Sciences Centre, Eastern Health Authority, St. John’s, Newfoundland and Labrador Canada
| | - Shannon Carter
- Provincial Medical Genetics Program, Health Sciences Centre, Eastern Health Authority, St. John’s, Newfoundland and Labrador Canada
| | - Sarah Predham
- Provincial Medical Genetics Program, Health Sciences Centre, Eastern Health Authority, St. John’s, Newfoundland and Labrador Canada
| | - Holly Etchegary
- Clinical Epidemiology, Faculty of Medicine, Memorial University, St. John’s, Newfoundland and Labrador Canada
| | - Lesa Dawson
- Gynecologic Oncology, Faculty of Medicine, Memorial University, St. John’s, Newfoundland and Labrador Canada
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Richardson M, Min HJ, Hong Q, Compton K, Mung SW, Lohn Z, Nuk J, McCullum M, Portigal-Todd C, Karsan A, Regier D, Brotto LA, Sun S, Schrader KA. Oncology Clinic-Based Hereditary Cancer Genetic Testing in a Population-Based Health Care System. Cancers (Basel) 2020; 12:cancers12020338. [PMID: 32028617 PMCID: PMC7072228 DOI: 10.3390/cancers12020338] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 02/01/2020] [Accepted: 02/01/2020] [Indexed: 11/22/2022] Open
Abstract
New streamlined models for genetic counseling and genetic testing have recently been developed in response to increasing demand for cancer genetic services. To improve access and decrease wait times, we implemented an oncology clinic-based genetic testing model for breast and ovarian cancer patients in a publicly funded population-based health care setting in British Columbia, Canada. This observational study evaluated the oncology clinic-based model as compared to a traditional one-on-one approach with a genetic counsellor using a multi-gene panel testing approach. The primary objectives were to evaluate wait times and patient reported outcome measures between the oncology clinic-based and traditional genetic counselling models. Secondary objectives were to describe oncologist and genetic counsellor acceptability and experience. Wait times from referral to return of genetic testing results were assessed for 400 patients with breast and/or ovarian cancer undergoing genetic testing for hereditary breast and ovarian cancer from June 2015 to August 2017. Patient wait times from referral to return of results were significantly shorter with the oncology clinic-based model as compared to the traditional model (403 vs. 191 days; p < 0.001). A subset of 148 patients (traditional n = 99; oncology clinic-based n = 49) completed study surveys to assess uncertainty, distress, and patient experience. Responses were similar between both models. Healthcare providers survey responses indicated they believed the oncology clinic-based model was acceptable and a positive experience. Oncology clinic-based genetic testing using a multi-gene panel approach and post-test counselling with a genetic counsellor significantly reduced wait times and is acceptable for patients and health care providers.
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Affiliation(s)
- Matthew Richardson
- Interdisciplinary Oncology Program, Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada;
| | - Hae Jung Min
- Hereditary Cancer Program, BC Cancer, Vancouver, BC V5Z 1K1, Canada; (H.J.M.); (Q.H.); (K.C.); (S.W.M.); (Z.L.); (J.N.); (M.M.); (C.P.-T.)
| | - Quan Hong
- Hereditary Cancer Program, BC Cancer, Vancouver, BC V5Z 1K1, Canada; (H.J.M.); (Q.H.); (K.C.); (S.W.M.); (Z.L.); (J.N.); (M.M.); (C.P.-T.)
| | - Katie Compton
- Hereditary Cancer Program, BC Cancer, Vancouver, BC V5Z 1K1, Canada; (H.J.M.); (Q.H.); (K.C.); (S.W.M.); (Z.L.); (J.N.); (M.M.); (C.P.-T.)
| | - Sze Wing Mung
- Hereditary Cancer Program, BC Cancer, Vancouver, BC V5Z 1K1, Canada; (H.J.M.); (Q.H.); (K.C.); (S.W.M.); (Z.L.); (J.N.); (M.M.); (C.P.-T.)
| | - Zoe Lohn
- Hereditary Cancer Program, BC Cancer, Vancouver, BC V5Z 1K1, Canada; (H.J.M.); (Q.H.); (K.C.); (S.W.M.); (Z.L.); (J.N.); (M.M.); (C.P.-T.)
| | - Jennifer Nuk
- Hereditary Cancer Program, BC Cancer, Vancouver, BC V5Z 1K1, Canada; (H.J.M.); (Q.H.); (K.C.); (S.W.M.); (Z.L.); (J.N.); (M.M.); (C.P.-T.)
| | - Mary McCullum
- Hereditary Cancer Program, BC Cancer, Vancouver, BC V5Z 1K1, Canada; (H.J.M.); (Q.H.); (K.C.); (S.W.M.); (Z.L.); (J.N.); (M.M.); (C.P.-T.)
| | - Cheryl Portigal-Todd
- Hereditary Cancer Program, BC Cancer, Vancouver, BC V5Z 1K1, Canada; (H.J.M.); (Q.H.); (K.C.); (S.W.M.); (Z.L.); (J.N.); (M.M.); (C.P.-T.)
| | - Aly Karsan
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC V6T 2B5, Canada;
| | - Dean Regier
- Department of School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada;
- Cancer Control Research, BC Cancer, Vancouver, BC V5Z 1L3, Canada
| | - Lori A. Brotto
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of British Columbia, Vancouver, BC V6Z 2K8, Canada;
| | - Sophie Sun
- Hereditary Cancer Program, BC Cancer, Vancouver, BC V5Z 1K1, Canada; (H.J.M.); (Q.H.); (K.C.); (S.W.M.); (Z.L.); (J.N.); (M.M.); (C.P.-T.)
- Division of Medical Oncology, Faculty of Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
- Department of Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
- Correspondence: (S.S.); (K.A.S.); Tel.: +604-877-6000 (ext. 2752) (S.S.); +604-877-6000 (ext. 672324) (K.A.S.)
| | - Kasmintan A. Schrader
- Hereditary Cancer Program, BC Cancer, Vancouver, BC V5Z 1K1, Canada; (H.J.M.); (Q.H.); (K.C.); (S.W.M.); (Z.L.); (J.N.); (M.M.); (C.P.-T.)
- Department of Medical Genetics, University of British Columbia, Vancouver, BC V6H 3N1, Canada
- Department of Molecular Oncology, BC Cancer, Vancouver, BC V5Z 1G1, Canada
- Correspondence: (S.S.); (K.A.S.); Tel.: +604-877-6000 (ext. 2752) (S.S.); +604-877-6000 (ext. 672324) (K.A.S.)
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McCuaig JM, Tone AA, Maganti M, Romagnuolo T, Ricker N, Shuldiner J, Rodin G, Stockley T, Kim RH, Bernardini MQ. Modified panel-based genetic counseling for ovarian cancer susceptibility: A randomized non-inferiority study. Gynecol Oncol 2019; 153:108-115. [DOI: 10.1016/j.ygyno.2018.12.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 12/21/2018] [Accepted: 12/28/2018] [Indexed: 12/27/2022]
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Next-Generation Service Delivery: A Scoping Review of Patient Outcomes Associated with Alternative Models of Genetic Counseling and Genetic Testing for Hereditary Cancer. Cancers (Basel) 2018; 10:cancers10110435. [PMID: 30428547 PMCID: PMC6266465 DOI: 10.3390/cancers10110435] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 11/06/2018] [Accepted: 11/09/2018] [Indexed: 01/19/2023] Open
Abstract
The combination of increased referral for genetic testing and the current shortage of genetic counselors has necessitated the development and implementation of alternative models of genetic counseling and testing for hereditary cancer assessment. The purpose of this scoping review is to provide an overview of the patient outcomes that are associated with alternative models of genetic testing and genetic counseling for hereditary cancer, including germline-only and tumor testing models. Seven databases were searched, selecting studies that were: (1) full-text articles published ≥2007 or conference abstracts published ≥2015, and (2) assessing patient outcomes of an alternative model of genetic counseling or testing. A total of 79 publications were included for review and synthesis. Data-charting was completed using a data-charting form that was developed by the study team for this review. Seven alternative models were identified, including four models that involved a genetic counselor: telephone, telegenic, group, and embedded genetic counseling models; and three models that did not: mainstreaming, direct, and tumor-first genetic testing models. Overall, these models may be an acceptable alternative to traditional models on knowledge, patient satisfaction, psychosocial measures, and the uptake of genetic testing; however, particular populations may be better served by traditional in-person genetic counseling. As precision medicine initiatives continue to advance, institutions should consider the implementation of new models of genetic service delivery, utilizing a model that will best serve the needs of their unique patient populations.
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Bednar EM, Walsh MT, Baker E, Muse KI, Oakley HD, Krukenberg RC, Dresbold CS, Jenkinson SB, Eppolito AL, Teed KB, Klein MH, Morman NA, Bowdish EC, Russ P, Wise EE, Cooper JN, Method MW, Henson JW, Grainger AV, Arun BK, Lu KH. Creation and Implementation of an Environmental Scan to Assess Cancer Genetics Services at Three Oncology Care Settings. J Genet Couns 2018; 27:10.1007/s10897-018-0262-4. [PMID: 29770910 PMCID: PMC6240000 DOI: 10.1007/s10897-018-0262-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 05/06/2018] [Indexed: 02/03/2023]
Abstract
An environmental scan (ES) is an efficient mixed-methods approach to collect and interpret relevant data for strategic planning and project design. To date, the ES has not been used nor evaluated in the clinical cancer genetics setting. We created and implemented an ES to inform the design of a quality improvement (QI) project to increase the rates of adherence to national guidelines for cancer genetic counseling and genetic testing at three unique oncology care settings (OCS). The ES collected qualitative and quantitative data from reviews of internal processes, past QI efforts, the literature, and each OCS. The ES used a data collection form and semi-structured interviews to aid in data collection. The ES was completed within 6 months, and sufficient data were captured to identify opportunities and threats to the QI project's success, as well as potential barriers to, and facilitators of guideline-based cancer genetics services at each OCS. Previously unreported barriers were identified, including inefficient genetic counseling appointment scheduling processes and the inability to track referrals, genetics appointments, and genetic test results within electronic medical record systems. The ES was a valuable process for QI project planning at three OCS and may be used to evaluate genetics services in other settings.
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Affiliation(s)
- Erica M Bednar
- The Department of Clinical Cancer Genetics, The University of Texas MD Anderson Cancer Center, Unit 1362 P.O. Box 301439, Houston, TX, 77230-1439, USA.
- The Cancer Prevention and Control Platform, Moon Shots Program™, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Michael T Walsh
- The Cancer Prevention and Control Platform, Moon Shots Program™, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ellen Baker
- The Cancer Prevention and Control Platform, Moon Shots Program™, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kimberly I Muse
- The Department of Clinical Cancer Genetics, The University of Texas MD Anderson Cancer Center, Unit 1362 P.O. Box 301439, Houston, TX, 77230-1439, USA
| | - Holly D Oakley
- The Department of Clinical Cancer Genetics, The University of Texas MD Anderson Cancer Center, Unit 1362 P.O. Box 301439, Houston, TX, 77230-1439, USA
| | | | - Cara S Dresbold
- Oncology Genetic Counseling, Community Health Network, Indianapolis, IN, USA
| | - Sandra B Jenkinson
- Oncology Genetic Counseling, Community Health Network, Indianapolis, IN, USA
| | | | - Kelly B Teed
- Piedmont Cancer, Piedmont Healthcare, Atlanta, GA, USA
| | - Molly H Klein
- Piedmont Cancer, Piedmont Healthcare, Atlanta, GA, USA
| | | | | | - Pauline Russ
- Genetic Counseling Program, OhioHealth, Columbus, OH, USA
| | - Emaline E Wise
- Genetic Counseling Program, OhioHealth, Columbus, OH, USA
| | - Julia N Cooper
- Genetic Counseling Program, OhioHealth, Columbus, OH, USA
| | - Michael W Method
- Gynecologic Cancer Care, Community Health Network, Indianapolis, IN, USA
| | - John W Henson
- Piedmont Cancer, Piedmont Healthcare, Atlanta, GA, USA
| | | | - Banu K Arun
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Karen H Lu
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Watson CH, Ulm M, Blackburn P, Smiley L, Reed M, Covington R, Bokovitz L, Tillmanns T. Video-assisted genetic counseling in patients with ovarian, fallopian and peritoneal carcinoma. Gynecol Oncol 2016; 143:109-112. [PMID: 27416795 PMCID: PMC9813871 DOI: 10.1016/j.ygyno.2016.07.094] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 07/06/2016] [Accepted: 07/07/2016] [Indexed: 01/11/2023]
Abstract
OBJECTIVES To compare the proportion of patients with ovarian, fallopian or peritoneal carcinoma who receive genetic testing after observing a genetic counseling video versus after traditional referral for genetic counseling and testing at physician discretion. METHODS A retrospective chart review was performed of all patients seen at the West Cancer Center for evaluation of ovarian, fallopian or peritoneal carcinoma from 7/2014 to 8/2015. Patients seen between 7/2014 and 12/2014 were offered standard genetic counseling. We adopted a new standard of care from 3/2015 to 8/2015 involving the use of a genetic counseling video on a digital tablet. The video was shown to patients with ovarian, fallopian or peritoneal cancer, who were then given the option to undergo genetic testing at the end of the viewing. We compared the number and proportion of patients who received genetic testing in both groups. RESULTS The initial group of 267 patients received referral and te\sting at the physician's discretion between 8/2014 and 12/2014. 77/267 (29%) of these patients underwent genetic testing. 295 patients viewed the condensed genetic counseling video with the option to receive testing the same day between 3/2015 and 8/2015. 162/295 (55%) of these patients received testing. The transition from a referral method to the video counseling method resulted in a significant increase of patients tested (p<0.001). CONCLUSION Using a genetic counseling video and providing an immediate option for testing significantly increased the proportion of patients with ovarian, fallopian or peritoneal carcinoma who received genetic testing.
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Affiliation(s)
- Catherine H. Watson
- University of Tennessee Health Sciences Center, Department of OB/GYN, United States,Corresponding author at: University of Tennessee Health Sciences Center, Department of Obstetrics and Gynecology, 853 Jefferson Avenue, Rm E102, Memphis, TN 38163, United States. (C.H. Watson)
| | - Michael Ulm
- West Cancer Center, Memphis, TN, United States
| | - Patrick Blackburn
- University of Tennessee Health Sciences Center, Department of OB/GYN, United States
| | | | - Mark Reed
- West Cancer Center, Memphis, TN, United States
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Buchanan AH, Rahm AK, Williams JL. Alternate Service Delivery Models in Cancer Genetic Counseling: A Mini-Review. Front Oncol 2016; 6:120. [PMID: 27242960 PMCID: PMC4865495 DOI: 10.3389/fonc.2016.00120] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 04/28/2016] [Indexed: 11/13/2022] Open
Abstract
Demand for cancer genetic counseling has grown rapidly in recent years as germline genomic information has become increasingly incorporated into cancer care, and the field has entered the public consciousness through high-profile celebrity publications. Increased demand and existing variability in the availability of trained cancer genetics clinicians place a priority on developing and evaluating alternate service delivery models for genetic counseling. This mini-review summarizes the state of science regarding service delivery models, such as telephone counseling, telegenetics, and group counseling. Research on comparative effectiveness of these models in traditional individual, in-person genetic counseling has been promising for improving access to care in a manner acceptable to patients. Yet, it has not fully evaluated the short- and long-term patient- and system-level outcomes that will help answer the question of whether these models achieve the same beneficial psychosocial and behavioral outcomes as traditional cancer genetic counseling. We propose a research agenda focused on comparative effectiveness of available service delivery models and how to match models to patients and practice settings. Only through this rigorous research can clinicians and systems find the optimal balance of clinical quality, ready and secure access to care, and financial sustainability. Such research will be integral to achieving the promise of genomic medicine in oncology.
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Affiliation(s)
| | | | - Janet L. Williams
- Geisinger Health System, Genomic Medicine Institute, Danville, PA, USA
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11
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Analysis of Advantages, Limitations, and Barriers of Genetic Counseling Service Delivery Models. J Genet Couns 2016; 25:1010-8. [DOI: 10.1007/s10897-016-9932-2] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 01/07/2016] [Indexed: 10/22/2022]
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12
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A group approach to genetic counselling of cardiomyopathy patients: satisfaction and psychological outcomes sufficient for further implementation. Eur J Hum Genet 2015; 23:1462-7. [PMID: 25649380 PMCID: PMC4613479 DOI: 10.1038/ejhg.2015.10] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 12/22/2014] [Accepted: 01/07/2015] [Indexed: 11/11/2022] Open
Abstract
The introduction of next-generation sequencing in everyday clinical genetics practise is increasing the number of genetic disorders that can be confirmed at DNA-level, and consequently increases the possibilities for cascade screening. This leads to a greater need for genetic counselling, whereas the number of professionals available to provide this is limited. We therefore piloted group genetic counselling for symptomatic cardiomyopathy patients at regional hospitals, to assess whether this could be an acceptable alternative to individual counselling. We performed a cohort study with pre- and post-counselling patient measurements using questionnaires, supplemented with evaluations of the group counselling format by the professionals involved. Patients from eight regional hospitals in the northern part of the Netherlands were included. Questionnaires comprised patient characteristics, psychological measures (personal perceived control (PPC), state and trait anxiety inventory (STAI)), and satisfaction with counsellors, counselling content and design. In total, 82 patients (mean age 57.5 year) attended one of 13 group sessions. Median PPC and STAI scores showed significantly higher control and lower anxiety after the counselling. Patients reported they were satisfied with the counsellors, and almost 75% of patients were satisfied with the group counselling. Regional professionals were also, overall, satisfied with the group sessions. The genetics professionals were less satisfied, mainly because of their perceived large time investment and less-than-expected group interaction. Hence, a group approach to cardiogenetic counselling is feasible, accessible, and psychologically effective, and could be one possible approach to counselling the increasing patient numbers in cardiogenetics.
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Lynch HT, Snyder C, Stacey M, Olson B, Peterson SK, Buxbaum S, Shaw T, Lynch PM. Communication and technology in genetic counseling for familial cancer. Clin Genet 2013; 85:213-22. [PMID: 24355094 DOI: 10.1111/cge.12317] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Revised: 11/01/2013] [Accepted: 11/01/2013] [Indexed: 12/13/2022]
Abstract
When a cancer predisposing germline mutation is detected in an index case, the presence of the underlying syndrome is confirmed and the potential for predictive testing of at-risk relatives is established. However, the reporting of a positive family history does not routinely lead to communication of information about risk to close, much less distant relatives. This review summarizes information technology utilized to address penetration or 'reach' of knowledge of risk within extended families, including the use of telephone and video counseling to reach distant patients, and anticipate novel internet-based processes for communication between investigators and relatives.
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Affiliation(s)
- H T Lynch
- Department of Preventive Medicine and Public Health, Creighton University, Omaha, NE, USA
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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.
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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,
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Lee J, Cho HJ, Yoo HW, Park SK, Yang JJ, Kim SW, Kang E, Ahn SH, Lee SJ, Suh YJ, Kim SY, Kim EK, Moon NM, Lee MH. The effects of a genetic counseling educational program on hereditary breast cancer for korean healthcare providers. J Breast Cancer 2013; 16:335-41. [PMID: 24155764 PMCID: PMC3800731 DOI: 10.4048/jbc.2013.16.3.335] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 08/13/2013] [Indexed: 11/30/2022] Open
Abstract
Purpose Systematic educational programs and genetic counseling certification courses for hereditary breast/ovarian cancer (HBOC) have not yet been introduced in Korea. We provided and evaluated the effects of genetic counseling education on Korean healthcare providers' knowledge, awareness, and counseling skills for patients at high risk of HBOC. Methods A 3-day educational program was conducted for healthcare providers who were interested in genetic counseling for patients at high risk of HBOC. Participants who completed a knowledge test and satisfaction questionnaire were included in the present sample. Pre-post comparisons were conducted to determine the effects of the intervention. Results Significant differences between preprogram and postprogram knowledge scores were observed (p=0.002). Awareness (p<0.001) and confidence (p<0.001) regarding genetic counseling significantly increased after the training. Doctors and participants with fewer years of work experience performed well on the knowledge test. Previous educational experience was correlated with increased confidence in knowledge and counseling skills. Conclusion Genetic counseling education regarding HBOC improved knowledge and awareness of HBOC and enhanced confidence in the counseling process. The effects varied according to occupation and participants' previous education. The implementation of systematic educational programs that consider participant characteristics may improve the effects of such interventions.
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Affiliation(s)
- Jihyoun Lee
- Department of Surgery, Soonchunhyang University Seoul Hospital, Seoul, Korea
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Cohen SA, Gustafson SL, Marvin ML, Riley BD, Uhlmann WR, Liebers SB, Rousseau JA. Report from the National Society of Genetic Counselors service delivery model task force: a proposal to define models, components, and modes of referral. J Genet Couns 2012; 21:645-51. [PMID: 22566244 DOI: 10.1007/s10897-012-9505-y] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Accepted: 04/19/2012] [Indexed: 12/01/2022]
Abstract
The Service Delivery Model Task Force (SDMTF) was appointed in 2009 by the leadership of the National Society of Genetic Counselors (NSGC) with a charge to research and assess the capacity of all existing service delivery models to improve access to genetic counseling services in the context of increasing demand for genetic testing and counseling. In approaching this charge, the SDMTF found that there were varying interpretations of what was meant by "service delivery models" and the group held extensive discussions about current practices to arrive at consensus of proposed definitions for current genetic service delivery models, modes of referral and components of service delivery. The major goal of these proposed definitions is to allow for conversations to begin to address the charge to the committee. We propose that current models of service delivery can be defined by: 1) the methods in which genetic counseling services are delivered (In-person, Telephone, Group and Telegenetics), 2) the way they are accessed by patients (Traditional referral, Tandem, Triage, Rescue and Self-referral) and 3) the variable components that depend upon multiple factors unique to each service setting. This report by the SDMTF provides a starting point whereby standardized terminology can be used in future studies that assess the effectiveness of these described models to overcome barriers to access to genetic counseling services.
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Affiliation(s)
- Stephanie A Cohen
- Cancer Genetics Risk Assessment Program, St. Vincent Hospital, Indianapolis, IN 46260, USA.
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Rothwell E, Kohlmann W, Jasperson K, Gammon A, Wong B, Kinney A. Patient outcomes associated with group and individual genetic counseling formats. Fam Cancer 2012; 11:97-106. [PMID: 22057473 PMCID: PMC7462715 DOI: 10.1007/s10689-011-9486-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Identifying new methods to deliver cancer genetic counseling (GC) are needed to meet the growing interest in BRCA1/2 testing. The goal of this pilot feasibility study was designed to test the initial acceptability of group GC on selected patient outcomes (satisfaction, distress, perceived control) in a breast/ovarian cancer genetics clinic setting. Sixty-five participants at increased risk for hereditary breast/ovarian cancer (HBOC) agreed to participate in self-selected individual or group GC appointments. Forty-nine participants completed all study questionnaires and were included in the analyses. There were significant improvements for participants in both the individual and group GC formats with regard to perceived personal control, general psychological distress and cancer-specific psychological distress scores. Participants in both the individual and group formats reported high satisfaction scores on the Genetic Counseling Satisfaction Scale. Study results suggest that group GC may be feasible and acceptable to high-risk women.
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Affiliation(s)
- Erin Rothwell
- College of Nursing, University of Utah, Salt Lake City, UT 84112, USA.
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