Abstract
BackgroundGenetic 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.MethodsPatients 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.ResultsSixty 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.ConclusionsGroup 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.
Highlights
Genetic counselling (GC) is an integral component in the care of individuals at risk for hereditary cancer predisposition syndromes (CPS)
This paper describes the implementation of a group+mini individual genetic counselling model and presents patient satisfaction data collected during the initiative
The majority strongly agreed that they were comfortable with the group session (58/60; 97%), that the explanation of cancer genetics was clear (54/59; 92%), that they understood their cancer risks (54/59; 92%), and that the appointment was helpful to them (57/60; 95%)
Summary
Genetic counselling (GC) is an integral component in the care of individuals at risk for hereditary cancer predisposition syndromes (CPS). 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. Hereditary Cancer Predisposition Syndromes (CPS) are an important contributor to the burden of cancer in Canada Most commonly, these cancers are a result of BRCA-associated breast and ovarian cancer syndromes or hereditary gastrointestinal malignancy syndromes such as Lynch Syndrome [1]. A woman with a pathogenic variant (PV) in BRCA1 or 2 has lifetime risk of breast cancer and ovarian cancer of 50– 70% and 20–40% respectively, rates which are 5–15 times the usual population rates [2,3,4]. Beyond the prevention of subsequent cancers in the individual and the opportunities for prevention in relatives, the identification of those who carry PVs in these genes has become important in the tailoring of personalized cancer therapeutics such as PARP inhibitors for ovarian and breast cancers and anti-PD-1 monoclonal antibody-based agents for Lynch Syndrome associated colorectal cancer [9,10,11]
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