Active Members Research Articles

Behavioral Health Integrated Support Network (BHISN).

This article reviews process and performance of an innovative effort leveraging virtual health to manage unmet demand for behavioral health and substance use disorder services across a large military region. This effort began in June 2022 and included nearly all of the Defense Health Agency Region-Europe's military behavioral health and substance abuse clinics participating. The two goals of improving access to behavioral health and substance use services for active duty service members and improving utilization of the military clinics were employed. Operational and remote locations with known care gaps could access services as well. Connecting services to the point of need is an established strength of virtual health delivery systems of care. A team consisting of clinical leaders and Virtual Medical Center-Europe staff developed a centralized screening process and simple business rules. When a clinic was unable to meet its access-to-care standard of 28 days, the patient requesting or referral from a remote location, was offered a virtual video option with a provider from another clinic with availability. Centralized screening was created and staffed by three technicians. The Behavioral Health Integrated Support Network (BHISN) screening clinic assessed appropriateness of virtual care using established exclusion criteria. Once screened, the patient was scheduled for an appointment with one of the 31 therapists in 14 participating clinics in a 3- to 5-day window. The military health system's video connect platform was used. Between June 2022 and November 2023, 131 patients who were unable to find routine care in their home clinic were screened, scheduled, and completed a virtual visit with one of the 31 participating therapists from 14 behavioral health and substance use clinics. Seventy-eight (59%) participants were active duty empaneled to military treatment facilities in Europe and 53 (39%) were active duty enrolled in Tricare Prime Remote and deployed to remote locations with limited care. Forty-four percent of patients were recommended for continued virtual therapy or counseling kept their first follow-up demonstrating good follow-up care using a virtual option. The overall no-show rate was low at 7%. Care and consultation were successfully delivered using video visits to location in 18 countries in three geographic Europe, the Middle East and, Africa. The Virtual Medical Center-Europe, Army Europe Behavioral Health, and Substance Use leadership work collaboratively to plan and optimize program performance. For BHISN to function as intended requires key dedicated support staff, such as mental health and social services assistants to screen and coordinate virtual care. Scheduling can be performed by a central cell requiring clinics to relinquish some local control in the interest of meeting patient demand in large and diverse area that covers three continents. BHISN shows promising initial success by providing a process of managing demand and connecting requests for behavioral health and substance use care leveraging capacity from all clinics using a virtual video service in a diverse operating environment.

Cognitive-Communication Disorders and Neurodisability in the Criminal Justice System: Emerging Roles, Responsibilities, and Opportunities for Speech-Language Pathologists

Purpose: The purpose of this clinical focus article is to provide a framework for speech-language pathologists (SLPs) supporting youth and adults in the criminal justice system (CJS) who have cognitive-communication disorders (CCDs) related to neurodisability. Method: We provide an overview of communication disorders and CCDs in the CJS as well as the underlying etiologies leading to neurodisability, with a primary focus on traumatic brain injury. Additionally, we provide a framework for understanding the underlying factors that contribute to criminalization and recidivism as well as elucidate the role of SLPs in the context of the CJS. Results: SLPs have an important role to play with youth and adults in the CJS and should be routinely involved in the screening of communication disorders; in the provision of assessments, intervention, education, and training; and in advocacy roles. Conclusion: The high prevalence of CCDs in the CJS affords a unique and important role for SLPs to be active members of the interdisciplinary justice team, which, ultimately, may improve outcomes and reduce the cycle of recidivism.

NET4 and RabG3 link actin to the tonoplast and facilitate cytoskeletal remodelling during stomatal immunity

Members of the NETWORKED (NET) family are involved in actin-membrane interactions. Here we show that two members of the NET family, NET4A and NET4B, are essential for normal guard cell actin reorganization, which is a process critical for stomatal closure in plant immunity. NET4 proteins interact with F-actin and with members of the Rab7 GTPase RABG3 family through two distinct domains, allowing for simultaneous localization to actin filaments and the tonoplast. NET4 proteins interact with GTP-bound, active RABG3 members, suggesting their function being downstream effectors. We also show that RABG3b is critical for stomatal closure induced by microbial patterns. Taken together, we conclude that the actin cytoskeletal remodelling during stomatal closure involves a molecular link between actin filaments and the tonoplast, which is mediated by the NET4-RABG3b interaction. We propose that stomatal closure to microbial patterns involves the coordinated action of immune-triggered osmotic changes and actin cytoskeletal remodelling likely driving compact vacuolar morphologies.

Aerobic exercise improves sleep in U. S. active duty service members following brief treatment for posttraumatic stress disorder symptoms.

Physical exercise is a lifestyle intervention that can positively impact aspects of physical and psychological health. There is a growing body of evidence suggesting that physical exercise, sleep, and PTSD are interrelated. This study investigated possible relationships. Three research questions were posed: (1) Did randomization to an aerobic exercise intervention reduce insomnia more than being randomized to an intervention without exercise, (2) Did change in sleep predict change in PTSD symptoms, and (3) Did change in sleep impact the relationship between exercise and PTSD symptom reductions? Data were collected from 69 treatment-seeking active duty service members with PTSD symptoms randomized into one of four conditions; two conditions included aerobic exercise, and two conditions did not include exercise. Participants in the exercise groups exercised five times per week keeping their heart rate > 60% of their heart rate reserve for 20-25 min. At baseline, 58% of participants reported moderate or severe insomnia. PTSD symptom severity decreased following treatment for all groups (p < 0.001). Participants randomized to exercise reported greater reductions in insomnia compared to those in the no exercise group (p = 0.47). However, change in insomnia did not predict change in PTSD symptoms nor did it significantly impact the relationship between exercise and PTSD symptom reductions. Adding exercise to evidence-based treatments for PTSD could reduce sleep disturbance, a characteristic of PTSD not directly addressed with behavioral therapies. A better understanding of exercise as a lifestyle intervention that can reduce PTSD symptoms and insomnia is warranted.

Lifetime Traumatic Brain Injury and Risk of Post-Concussive Symptoms in the Millennium Cohort Study.

Traumatic brain injury (TBI) is prevalent among active duty military service members, with studies reporting up to 23% experiencing at least one TBI, with 10-60% of service members reporting at least one subsequent repeat TBI. A TBI has been associated with an increased risk of cumulative effects and long-term neurobehavioral symptoms, impacting operational readiness in the short-term and overall health in the long term. The association between multiple TBI and post-concussive symptoms (PCS), however, defined as symptoms that follow a concussion or TBI, in the military has not been adequately examined. Previous studies in military populations are limited by methodological issues including small sample sizes, the use of non-probability sampling, or failure to include the total number of TBI. To overcome these limitations, we examined the association between the total lifetime number of TBI and total number of PCS among U.S. active duty military service members who participated in the Millennium Cohort Study. A secondary data analysis was conducted using the Millennium Cohort Study's 2014 survey (n = 28,263) responses on self-reported TBI and PCS (e.g., fatigue, restlessness, sleep disturbances, poor concentration, or memory loss). Zero-inflated negative binomial models calculated prevalence ratios (PRs) and 95% confidence intervals (CIs) for the unadjusted and adjusted associations between lifetime TBIs and PCS. A third of military participants reported experiencing one or more TBIs during their lifetime with 72% reporting at least one PCS. As the mean number of PCS increased, mean lifetime TBIs increased. The mean number of PCS by those with four or more TBI (4.63) was more than twice that of those with no lifetime TBI (2.28). One, two, three, and four or more TBI had 1.10 (95% CI: 1.06-1.15), 1.19 (95% CI: 1.14-1.25), 1.23 (95% CI: 1.17-1.30), and 1.30 times (95% CI: 1.24-1.37) higher prevalence of PCS, respectively. The prevalence of PCS was 2.4 (95% CI: 2.32-2.48) times higher in those with post-traumatic stress disorder than their counterparts. Active duty military service members with a history of TBI are more likely to have PCS than those with no history of TBI. These results suggest an elevated prevalence of PCS as the number of TBI increased. This highlights the need for robust, longitudinal studies that can establish a temporal relationship between repetitive TBI and incidence of PCS. These findings have practical relevance for designing both workplace safety prevention measures and treatment options regarding the effect on and from TBI among military personnel.

NANN Membership Recommendations: Opportunities to Advance Racial Equity Within the Organization.

Neonatal care has advanced significantly in recent years, yet racial health inequities persist in the neonatal intensive care unit (NICU), with infants from racial and ethnic minority groups less likely to receive recommended treatment. Healthcare providers acknowledge that there are steps that can be taken to increase knowledge and awareness regarding health inequities. To better understand current health equity-related initiatives in the neonatal community and solicit feedback from National Association of Neonatal Nurses (NANN) membership about advancing racial equity within the organization. A cross-sectional survey was conducted in January 2021. The anonymous, onetime survey was distributed to active NANN members via SurveyMonkey and included questions related to racial equity initiatives, recommendations, and demographics. Data analysis was conducted using an exploratory approach using descriptive statistics, and thematic analysis was used to summarize responses to open-ended questions. There were 325 members who completed the full survey, of whom were White (83%), female (96%), staff nurses (42%), and those with more than 16 years of experience (69%), and most (69%) were familiar with NANN's racial equity position statement. Recommendations were summarized into the following themes: (1) research, (2) education, (3) workforce diversity, (4) communication, (5) scholarships, (6) resources, and (7) community outreach. NANN members offered clear and actionable recommendations to advance health equity within the neonatal community and organization, which included offering more diversity, inclusion, and equity education at the annual conferences, in ANC articles, and newsletters, and the creation of scholarships or reduced membership fees to encourage diverse enrollment in the organization.

Hidden Challenges Experienced by Families With Military-Related Post-Traumatic Stress Disorder

Family systems theory explains how post-traumatic stress disorder (PTSD) in the family affects family members who must cope with disturbing behaviors from the military member. Although military-related PTSD has been studied in the United States for over a decade, Canadian research is in its infancy. This article focuses on the challenges military families face for both active military members and retired veterans. Corbin and Strauss’ (2015) grounded theory was used to guide this study. Following theoretical sampling, semi-structured in-depth interviews were conducted with 21 non-military parents and 4 adult children in Alberta. The findings have important implications for military families, as well as practice, policy, and research on the topic. Further research could expand the sample to include military members/veterans and families across Canada.

Followership in interprofessional healthcare teams: a state-of-the-art narrative review

ObjectiveA state-of-the-art (SotA) literature review—a type of narrative review— was conducted to answer: What historical developments led to current conceptualisations of followership in interprofessional healthcare teams (IHTs)?DesignWorking from a constructivist...

OS02.5.A DEVELOPMENT OF A PATIENT DECISION AID FOR PATIENTS WITH RECURRENT HIGH-GRADE GLIOMA - A CO-CREATION PROCESS

Abstract BACKGROUND Patients with high-grade gliomas (HGG) face a difficult decision when the tumor recurs. There are no curable treatments, and all palliative treatment options include risks of complications and adverse effects. In this situation, support is needed for patients to navigate between these trade-offs and make preference-sensitive decisions. Shared decision making (SDM) is an approach where a decision is made in collaboration between a clinician and a patient by combining the clinician’s scientific evidence and knowledge with the patient’s subjective values and preferences. SDM aims to make quality decisions congruent with the individual patient’s informed preferences and to support patients in the decisional process. Patient decision aids (PtDA’s) have proven to be an efficient tool for facilitating SDM. However, there are no PtDA’s available for patients with recurrent HGG. This study aimed to develop a PtDA in a co-creation process with patients with recurrent HGG and family caregivers MATERIAL AND METHODS Based on the International Patient Decision Aids Standards, our team developed a PtDA through an iterative process of drafting and re-drafting. Patients and family caregivers were involved throughout the process as active team members. The PtDA was alpha-tested using structured interviews and the Preparation for Decision Making Scale questionnaire to assess the understandability, acceptability, and perceived usefulness of the PtDA. Data were analyzed using descriptive statistics and a directed content-analysis approach. RESULTS The final draft of the PtDA contained six treatment and care options, including the option of doing nothing. A balanced presentation of benefits and disadvantages was described for each option. In the alpha test, 31 patients with HGG, family caregivers, and clinicians assessed the final draft of the PtDA and found it to be understandable and acceptable. Patients and family caregivers perceived the PtDA to have a higher level of usefulness in supporting and preparing for decision making than did the clinicians (p=0.05). Ten of 11 clinicians were willing to use the PtDA in future consultations. CONCLUSION The PtDA was assessed to be understandable and acceptable by patients, family caregivers, and clinicians. It was perceived to support and prepare patients with recurrent HGG for decision making, and the clinicians were willing to use it in consultations. The involvement of patients and family caregivers as team members added value to the development process and the PtDA. However, the most applicable model of patient involvement in neurooncological research must be further explored to identify the benefits and limitations of approaches.

Climate Change Considerations in Public Library Collection Development

Climate change is one of the biggest threats to our continued existence. While resources and research about climate change are readily available, what do public libraries need to be doing, as one of the last free public spaces, to bridge the gap between complex information and community action? This extended abstract, based on a larger research paper, explores the various ways public libraries can be active members of their communities and promote conversations about climate change with the specific actions of their collection development. Through an in-depth literature search, several challenges are identified that act as barriers to creating cohesive, inclusive, and informative climate change-oriented collections. These barriers include eco-anxiety, particularly among children and young adults, environmental literacy, and climate change denial materials. Considering these challenges, recommendations are provided to overcome these obstacles. As the need for understanding and action becomes more dire, library policies and collection development strategies need to reflect those needs.

The impact of unequal contributions in student software engineering team projects

Unequal distribution of work is a common problem in student team projects, undermining learning objectives and reducing student satisfaction with teamwork. More is needed to be known about the impact of unequal distribution of work on the performance of student software engineering teams and their members and the relationship between objective measures of unequal contribution and team-perceived unequal contribution. A greater understanding of these issues allows for targeted and personalised responses to these behaviours. We investigated several aspects of unequal contribution in student software engineering teams. We measured inequality of contribution using Git data from student software engineering teams, source code quality using code analyser SonarQube, and the team performance using grades. According to our results, most students under-contributed to their teams, and at least half the teams in each assignment had low equality of contribution or extreme inequality of contribution. Individual contribution styles did not strongly persist between modules (one-semester-long software engineering courses). There were no consistent associations between inequality of contribution in the student teams and performance or code quality. When the contribution of the least active team member was less than 14% of their fair share, teams were likely to perceive an unequal distribution of contributions.

The Intersection between Alcohol use and Sexual Activity among Young Adult Male U.S. Service Members.

The current study explores drinking habits, preferences for alcohol use before sexual activity, and alcohol-related sexual behavior among young adult male active duty service members in the United States. Hazardous alcohol use is a significant problem among United States military service members. Whereas the association between alcohol use and sexual assault is well documented in civilian samples, less is known regarding the intersection of alcohol use and sexual activity among soldiers. Descriptive statistics were utilized to summarize drinking habits, preferences for alcohol use before sexual activity, and alcohol-related sexual behavior. A sample of 338 active-duty male service members between the ages of 18 and 24 were recruited from a large military post in the Southeastern United States. Constructs were assessed using self-report surveys. Participants reported consuming alcohol, on average, 5.6 times over the prior month. Average alcohol consumption was reported to be 7.8 beverages per drinking occasion. Participants reported engaging in heavy drinking an average of 2.9 times over the past 30 days. On average, service members reported a preference for 1.3 drinks before sexual activity. Furthermore, 75.2% of participants preferred to be sober during sex, and 82.1% preferred to engage in sexual activity with a sober partner. Approximately 14% of the sample reported using alcohol to improve their chances of having sex. These findings highlight high rates of alcohol use among soldiers. Nonetheless, young adult male soldiers report a preference for sexual activity while sober. Understanding the co-occurrence of alcohol use and sexual activity has the potential to inform the development of integrated alcohol and sexual assault prevention programs for service members.

Does adoption of cocoa hand pollination (CHP) improve welfare of farmers? Evidence from smallholder cocoa farmers in Ghana

ABSTRACT This paper evaluates the impact of the adoption of cocoa hand pollination (CHP) on the welfare of smallholder cocoa producers. Using data collected from 1200 cocoa farmers in Huni Valley and Kejebril districts of Ghana, we employed endogenous switching regression, propensity score matching and inverse probability weighted adjustment techniques to assess the impact. The two-step Cragg was used to examine the determinants of the decision and intensity of adoption. The results showed that education, marriage and farm size positively influenced both the decision and intensity of adoption of the CHP technique. The result further showed that the cost of labour for implementing the technology, age, education, family head, economic active members, age of the cocoa tree, off-farm work, credit access and farm size significantly determined the impact of adoption on smallholder cocoa producers’ welfare. Additionally, there is a positive impact of CHP adoption on productivity, income and food security. Careful consideration should be given to these factors including collaborations between government and stakeholders in the cocoa industry through the regular sensitization and trainings for farmers on improved technologies as the CHP to increase productivity, household income and reduce food insecurity of smallholder cocoa farmers.

Work engagement, psychological empowerment and relational coordination in long-term care: A mixed-method examination of nurses' perceptions and experiences.

Nurse engagement, empowerment and strong relationships among staff, residents and families, are essential to attract and retain a suitably qualified and skilled nursing workforce for safe, quality care. There is, however, limited research that explores engagement, empowerment and relational coordination in long-term care (LTC). Nurses from an older persons' mental health and dementia LTC unit in Australia participated in this study. Forty-one nurses completed a survey measuring psychological empowerment, work engagement and relational coordination. Twenty-nine nurses participated in individual interviews to further explore these concepts. Although nurses reported high psychological empowerment and work engagement, their relationships with key stakeholders varied. Our findings suggest that nurses in LTC require both supports and opportunities to contribute as active members of the multiprofessional care team that includes tailored education, professional development and positive interactions within the care team. Regular support is needed to enable nurses to feel empowered, foster relationships and communication, and facilitate work engagement. Based on these findings, we suggest that it is important to find ways to ensure that all who provide care perceive that they are part of the whole care team and able to contribute to the care and well-being of people in LTC.

Bridging Total Force Fitness and Whole Health in Cardiovascular Disease Prevention.

The Cardiovascular Disease (CVD) Prevention project is a VA-DoD initiative, supported by the Joint Incentive Fund. The goal of the project is to create an innovative, 3D virtual space within the VA-Virtual Medical Center (VA-VMC) platform that provides Veterans and Active Duty Service Members with educational resources on the prevention of CVD. The Performance Health and Wellness Center is a new center within the VA-VMC. The space enables users to explore information and actionable resources on various risk factors related to CVD through independent and provider-led instruction, using a personalized 3D avatar. Partners of DoD and VA envision users engaging with the learning resources securely and with a sense of anonymity, which can foster self-directed learning and healthy behavior change. The DoD is particularly invested in promoting CVD prevention through the early adoption of positive health behaviors and the Total Force Fitness framework. The VA team is also committed to supporting users by providing professionally led classes and support groups on various CVD risk factors like tobacco, diabetes, nutrition, and exercise. This project is a unique and important collaboration during a time when telehealth and telemedicine services are in greater demand. The VA-VMC advances accessible, relevant, and evidence-based educational services for DoD and VA populations, and the Performance Health and Wellness Center, itself, presents Total Force Fitness concepts and a whole-person care approach while encouraging users to be actively involved in shared decision-making with their health care providers.

Changing Practice Through Nursing Leadership: A Pediatric Oncology Unit in Delhi, India

The pediatric oncology unit at the Rajiv Gandhi Cancer Institute and Research Center (RGCI &amp; RC), a nonprofit medical facility and research institute based in Delhi, India, sought to improve clinical nursing practice through nurse leadership training supported by international nursing mentorship. A nursing team leadership program with a goal to strengthen practice was designed in collaboration with the RGCI &amp; RC nurse education department and pediatric oncology physicians on the unit. Two expert oncology nurses from the United States made multiple visits from 2017 to 2019 to support the development of the leadership program and the resulting practice changes. Specific areas of nursing addressed through these efforts included attention to education, practice, and leadership. Selected processes were improved by the following: (a) development of a pediatric oncology nursing orientation program to follow general onboarding by the nursing education department, (b) strengthening and updating standard operating procedures for nursing, and (c) development of a nursing Team Leads program. Four team leads completed training, and staff nurses are now active members in the care of patients and opining themselves when decision-making occurs during rounds. RGCI &amp; RC nurses have written abstracts and posters accepted at national and international conferences, which further strengthens their profile in the larger pediatric oncology professional community.

Exploring the protective experiences of those who "protect and serve": A psychometric evaluation of Protective and Compensatory Experiences Survey within a military sample.

The current study evaluates the psychometric properties of the Protective and Compensatory Experiences Survey (PACES; Morris et al., 2018) within a military population. The study's aims are to evaluate if the PACES is a reliable measure to use with military samples and to examine the validity of the PACES measure when exploring protective experiences in relation to adverse childhood experiences (ACEs) and adult traumatic stress (ATS) in an active duty military sample. Active duty Service members were recruited to complete an online survey that included measures pertaining to ACEs, PACES, and ATS. The reliability and validity of PACES indicate that Service members who are involved in protective and compensatory experiences as youth are less likely to have experiences of stress both as children and as adults. Given the need for mission readiness of Service members and their higher likelihood to experience ACEs than civilians, the role of protective and compensatory factors is vital to their livelihood and career. PACES psychometrics offer a reliable and valid measure to use when exploring the risk and resilience experiences of Service members across the lifespan. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Abstract P435: Barriers For Secondary Hypertension Screening In The Us: A National Physician Survey

Background: Although US and international expert guidelines recommend screening for secondary hypertension in patients with treatment-resistant hypertension (RHTN) and other high-risk groups, screening is conducted in &lt;3% of candidates. Objective: To determine barriers for secondary hypertension screening across US practices. Participants and Measurements: Internists, family practitioners, cardiologists, nephrologists, and endocrinologists, randomly selected from active members of the American Medical Association were surveyed on barriers for secondary hypertension screening. Results: Response rate was 67% (425 of 633 response-eligible physicians). The leading reported barriers preventing secondary hypertension screening included visit time constraints (43.5%), poor ancillary support (29.4%), and testing-related logistics (27.5%). Physicians practicing in large medical groups or staff-model HMO were more likely than physicians in private practice to not have access to specialists (adjusted OR, 95% CI: 4.01 [1.19-13.47]), and to be unfamiliar with screening results interpretation and next steps (2.11 [1.03-4.32]), but less likely to report poor ancillary support (0.47 [0.28-0.79]) or reimbursement concerns (0.29 [0.13-0.63]). Primary care physicians were more likely than endocrinologists (16.67 [2.04-100.00]) and nephrologists (10.00 [1.32-100.00] to lack familiarity with testing interpretation and subsequent steps. Physicians in practices covered primarily by Medicare were more likely to report poor ancillary support (2.02 [1.16-3.53]), and lack of access to specialists (4.96 [1.04-23.52]) as compared to physicians in practices covered primarily by private health insurance. Conclusions: Our findings suggest an urgent need to address major barriers to secondary hypertension screening, including ensuring adequate clinic visit time, ancillary support, and timely access to specialists.

Target benefit versus defined contribution scheme: a multi-period framework

AbstractA target benefit plan (TBP) is a collective defined contribution (DC) plan that is growing in popularity in Canada. Similar to DC plans, TBPs have fixed contribution rates, but they also implement pooling of longevity and investment risk. In this paper, we formulate a multi-period model that incorporates two sources of risk – asset risk and labor income risk for active members. We present an optimal investment and retirement benefits schedule for TBP members with a fixed contribution rate. Using Australian data from 1965 to 2018, we evaluate the performance of the optimal TBP scheme and compare it to the optimal DC scheme. By adopting the benefit–investment strategy derived in this paper, we demonstrate the stability of benefit distribution over time for a TBP scheme in this stochastic formulation. To outperform the DC scheme’s benefit payment, careful consideration shall be given to the benefit target in the TBP scheme. A high target may not be achievable, while a low target can impede the accumulation momentum of the fund’s wealth in its early stages. Moreover, a TBP fund’s investment strategy is primarily influenced by the wealth target, with more aggressive investments in risky assets as the wealth target increases. This analysis may shed light on the possible improvements to retirement planning in Australia. Although the results are sensitive to the choice of model parameters, overall, the proposed TBP promotes system stability in various scenarios.

Exploring Stakeholders' Perspectives on Implementing Universal Germline Testing for Colorectal Cancer: Findings From a Clinical Practice Survey.

New guidelines recommend considering germline genetic testing for all patients with colorectal cancer (CRC). However, there is a lack of data on stakeholders' perspectives on the advantages and barriers of implementing universal germline testing (UGT). This study assessed the perspectives of members of the Collaborative Group of the Americas on Inherited Gastrointestinal Cancer (CGA-IGC) regarding the implementation of UGT for patients with CRC, including readiness, logistics, and barriers. A cross-sectional survey was sent to 317 active members of CGA-IGC. The survey included sections on demographics, clinical practice specialty, established institutional practices for testing, and questions pertaining to support of and barriers to implementing UGT for patients with CRC. Eighty CGA-IGC members (25%) participated, including 42 genetic counselors (53%) and 14 gastroenterologists (18%). Forty-seven (59%) reported an academic medical center as their primary work setting, and most participants (56%) had more than 10 years of clinical practice. Although most participants (73%) supported UGT, 54% indicated that changes in practice would be required before adopting UGT, and 39% indicated that these changes would be challenging to implement. There was support for both genetics and nongenetics providers to order genetic testing, and a majority (57%) supported a standardized multigene panel rather than a customized gene panel. Key barriers to UGT implementation included limited genetics knowledge among nongenetics providers, time-consuming processes for obtaining consent, ordering tests, disclosing results, and lack of insurance coverage. This study demonstrates wide support among hereditary GI cancer experts for implementation of UGT for patients with CRC. However, alternative service delivery models using nongenetics providers should be considered to address the logistical barriers to UGT implementation, particularly the growing demand for genetic testing.