Abstract
Integration of genetic testing into routine oncology care could improve access to testing. This systematic review investigated interventions and the tailored implementation strategies aimed at increasing access to genetic counselling and testing and identifying hereditary cancer in oncology. The search strategy results were reported using the PRISMA statement and four electronic databases were searched. Eligible studies included routine genetic testing for breast and ovarian cancer or uptake after universal tumour screening for colorectal or endometrial cancer. The titles and abstracts were reviewed and the full text articles screened for eligibility. Data extraction was preformed using a designed template and study appraisal was assessed using an adapted Newcastle Ottawa Scale. Extracted data were mapped to Proctor's et al outcomes and the Consolidated Framework for Implementation Research and qualitatively synthesised. Twenty-seven studies, published up to May 2020, met the inclusion criteria. Twenty-five studies ranged from poor (72%), fair to good (28%) quality. Most interventions identified were complex (multiple components) such as; patient or health professional education, interdisciplinary practice and a documentation or system change. Forty-eight percent of studies with complex interventions demonstrated on average a 35% increase in access to genetic counselling and a 15% increase in testing completion. Mapping of study outcomes showed that 70% and 32% of the studies aligned with either the service and client or the implementation level outcome and 96% to the process or inner setting domains of the Consolidated Framework for Implementation Research. Existing evidence suggests that complex interventions have a potentially positive effect towards genetic counselling and testing completion rates in oncology services. Studies of sound methodological quality that explore a greater breadth of pre and post implementation outcomes and informed by theory are needed. Such research could inform future service delivery models for the integration of genetics into oncology services.
Highlights
A challenge of optimising standards in oncology is the slow rate that evidence is adopted into clinical care, leading to inequity and variation between hospital settings [1, 2]
Peer Review History: PLOS recognizes the benefits of transparency in the peer review process; we enable the publication of all of the content of peer review and author responses alongside final, published articles
Existing evidence suggests that complex interventions have a potentially positive effect towards genetic counselling and testing completion rates in oncology services
Summary
A challenge of optimising standards in oncology is the slow rate that evidence is adopted into clinical care, leading to inequity and variation between hospital settings [1, 2]. Health services research identifies ways to ease the burden on cancer care provision, improve system inefficiencies and optimise standards [1, 2]. In the case of cancer germline genetic testing (GT), a systematic way to sustain implementation of GT is needed as this is increasingly being used in the assessment and care of patients in many specialities [3]. Medical specialists in oncology can order a panel of multiple genes to assess for hereditary breast and ovarian cancer (HBOC) [10] without prior referral to genetic services. This systematic review investigated interventions and the tailored implementation strategies aimed at increasing access to genetic counselling and testing and identifying hereditary cancer in oncology
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