Increasing genetic counseling referral rates after ovarian cancer diagnosis: Improving the quality of ovarian cancer care

Abstract

Objectives: Despite guidelines from the National Comprehensive Cancer Network (NCCN) in 2007 and Society of Gynecologic Oncology (SGO) in 2014 recommending universal genetic counseling referral for women with epithelial ovarian cancer (EOC), current rates are 14.5% to 32.3%. We aimed to increase our rate of genetic counseling referral using a toolkit based on the results of a practice gap analysis. Methods: All new EOC patients evaluated at a single academic tertiary referral cancer center from July 1, 2013, to December 31, 2013, were retrospectively identified, and a chart and electronic order review was performed. Clinicopathologic factors and whether genetic referral, counseling, and testing were completed were abstracted. A practice gap analysis was performed to identify points of intervention, and a multipronged toolkit (Table 1) was built with the goal of increasing genetic referral rates to 75%. The toolkit was implemented in April 2015. Data from new EOC patients evaluated from May 1, 2015, to June 30, 2015, was abstracted to determine postintervention referral rates. This was a quality improvement project involving a multidisciplinary team from oncology, genetics, and nursing. Results: The preintervention EOC cohort included 83 women with a primary presentation of EOC, with a mean age of 61.8 years at diagnosis. Sixty percent had stage III or IV disease, and serous histology was present in 59%. The postintervention EOC cohort included 23 women with primary EOC presentation, with a mean age of 60.6 years. Stage III or IV disease was present in 82.6%, and 60.9% had serous histology. Forty-one percent (34/83) of women in the preintervention cohort were referred for genetic counseling. After toolkit implementation, the referral rate increased to 91.3% (21/23; P < .05, with the Fisher exact test). In the preintervention cohort, 76.5% referred completed genetic counseling, and, of those, 77.0% underwent genetic testing. In the postintervention cohort, to date, 34.8% have completed genetic counseling, and 75% of them have undergone genetic testing thus far. Conclusions: Implementation of a multipronged toolkit designed to improve adherence to NCCN and SGO guidelines resulted in a significant increase in the genetic counseling referral rate among women with newly diagnosed EOC. Continued maintenance of this practice change is under way.Table 1A multipronged, low cost toolkit to increase the genetic counseling referral rate in women with epithelial ovarian cancer.