Abstract
New streamlined models for genetic counseling and genetic testing have recently been developed in response to increasing demand for cancer genetic services. To improve access and decrease wait times, we implemented an oncology clinic-based genetic testing model for breast and ovarian cancer patients in a publicly funded population-based health care setting in British Columbia, Canada. This observational study evaluated the oncology clinic-based model as compared to a traditional one-on-one approach with a genetic counsellor using a multi-gene panel testing approach. The primary objectives were to evaluate wait times and patient reported outcome measures between the oncology clinic-based and traditional genetic counselling models. Secondary objectives were to describe oncologist and genetic counsellor acceptability and experience. Wait times from referral to return of genetic testing results were assessed for 400 patients with breast and/or ovarian cancer undergoing genetic testing for hereditary breast and ovarian cancer from June 2015 to August 2017. Patient wait times from referral to return of results were significantly shorter with the oncology clinic-based model as compared to the traditional model (403 vs. 191 days; p < 0.001). A subset of 148 patients (traditional n = 99; oncology clinic-based n = 49) completed study surveys to assess uncertainty, distress, and patient experience. Responses were similar between both models. Healthcare providers survey responses indicated they believed the oncology clinic-based model was acceptable and a positive experience. Oncology clinic-based genetic testing using a multi-gene panel approach and post-test counselling with a genetic counsellor significantly reduced wait times and is acceptable for patients and health care providers.
Highlights
Emerging use of genetic testing to guide cancer therapies, combined with greater public and health care provider awareness, has led to rising demand for publicly funded cancer genetic services [1,2].This has resulted in longer wait times for patients to access genetic counselling and testing.Cancer genetic counselling has traditionally been modeled after services provided for families with Huntington’s disease where intensive one-on-one counselling before and after genetic testing is completed given the potential psychological consequences of a positive result for an untreatable disease [3]
This study demonstrated that oncology clinic-based genetic testing reduced overall patient wait times for genetic testing services, reduced costs, and was satisfactory for patients [12]
Patient reported outcome measures, and oncologist and genetic counsellor experience and compared the streamlined oncology clinic-based model to traditional one-on-one genetic counselling and genetic testing
Summary
Emerging use of genetic testing to guide cancer therapies, combined with greater public and health care provider awareness, has led to rising demand for publicly funded cancer genetic services [1,2].This has resulted in longer wait times for patients to access genetic counselling and testing.Cancer genetic counselling has traditionally been modeled after services provided for families with Huntington’s disease where intensive one-on-one counselling before and after genetic testing is completed given the potential psychological consequences of a positive result for an untreatable disease [3]. Emerging use of genetic testing to guide cancer therapies, combined with greater public and health care provider awareness, has led to rising demand for publicly funded cancer genetic services [1,2]. This has resulted in longer wait times for patients to access genetic counselling and testing. Given the rapidly expanding indications for genetic testing to guide oncologic treatment decision-making, alternative genetic counselling models must be explored to ensure timely access to results
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