Experience of urologists, oncologists and nurse practitioners with mainstream genetic testing in metastatic prostate cancer.

Abstract

International guidelines recommend germline genetic testing for men with metastatic prostate cancer. If offered to all patients by genetic healthcare professionals, there will be insufficient capacity to cope with the high patient numbers. In a mainstreaming pathway, non-genetic healthcare professionals (ngHCPs) discuss and order germline genetic testing instead of referring patients to genetic healthcare professionals. We aimed to evaluate the experience of ngHCPs with pre-test genetic counselling and to explore the feasibility from the ngHCPs' perspective. We carried out a prospective cohort study in 15 hospitals in the Netherlands. All participating ngHCPs (i.e. urologists, medical oncologists, specialist nurses and nurse practitioners) completed an online training module of 45 min. The ngHCPs completed a questionnaire both before the training and at three and nine months after it. Paired analyses were used to compare the first with the last questionnaires on attitude, confidence in the ability to discuss and order germline genetic testing, and perceived and actual knowledge of genetics and genetic testing. 167 ngHCPs were invited to participate of whom 69 completed the first questionnaire and started or completed the last one. They had a positive attitude towards offering genetic testing themselves. After nine months of providing pre-test genetic counselling, significantly more ngHCPs considered mainstreaming helpful (94% after versus 81% before, p = 0.01). Both perceived and actual knowledge increased significantly. Pre-test genetic counselling took less than 10 minutes for 82% of ngHCPs and the majority (88%) were in favour of continuing the mainstream pathway. Only six participating ngHCPs considered mainstreaming possible without completing a training module beforehand. After completing a short online training module, ngHCPs feel well-prepared to discuss germline genetic testing with metastatic prostate cancer patients.