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.
Highlights
The world of cancer genetics has experienced exponential growth in diagnostic and treatment opportunities that use genomic sequencing information, as was most recently acknowledged by the national Precision Medicine Initiative [1]
Cancer genetic counseling has traditionally been practiced in person, with patients traveling to a health-care facility to meet with a genetics clinician [9]
Alternate service delivery models have the potential for improving access to cancer genetic counseling, which is of growing importance as germline genomic information is increasingly incorporated into the care of individuals with cancer and their atrisk relatives
Summary
The world of cancer genetics has experienced exponential growth in diagnostic and treatment opportunities that use genomic sequencing information, as was most recently acknowledged by the national Precision Medicine Initiative [1]. Even before the Precision Medicine Initiative, demand for cancer genetic counseling grew as germline genetic testing became increasingly incorporated into breast and ovarian cancer treatment decisions [2, 3], public coverage of celebrity BRCA mutation status [4] reached a wide segment of the U.S population [5], and multi-gene panels for hereditary cancer susceptibility were introduced [6, 7] Due to these factors, cancer genetics clinicians across the U.S noted an increase in referrals for hereditary cancer risk assessment [8]. We present models in which genetics clinicians use alternate communication technologies to reach patients, followed by alternate visit models (group counseling and non-genetics clinician counseling) and direct-access testing models
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