A Comparison of Patient-Reported Outcomes Following Consent for Genetic Testing Using an Oncologist- or Genetic Counselor-Mediated Model of Care

Abstract

This study compares knowledge, experience and understanding of genetic testing, and psychological outcomes among breast and ovarian cancer patients undergoing multi-gene panel testing via genetic counselor-mediated (GMT) or oncologist-mediated (OMT) testing models. A pragmatic, prospective survey of breast and ovarian cancer patients pursuing genetic testing between January 2017 and August 2019 was conducted at the Princess Margaret Cancer Centre in Toronto, Canada. A total of 120 (80 GMT; 40 OMT) individuals completed a survey administered one week following consent to genetic testing. Compared to OMT, the GMT cohort had higher median knowledge (8 vs. 9; p = 0.025) and experience/understanding scores (8.5 vs. 10; p < 0.001) at the time of genetic testing. Significant differences were noted in the potential psychological concerns experienced, with individuals in the GMT cohort more likely to screen positive in the hereditary predisposition domain of the Psychosocial Aspects of Hereditary Cancer tool (55% vs. 27.5%; p = 0.005), and individuals in the OMT cohort more likely to screen positive in the general emotions domain (65.0% vs. 38.8%; p = 0.007). The results of this study suggest that OMT can be implemented to streamline genetic testing; however, post-test genetic counseling should remain available to all individuals undergoing genetic testing, to ensure any psychologic concerns are addressed and that individuals have a clear understanding of relevant implications and limitations of their test results.

Mainstreaming germline genetic testing for patients with pancreatic cancer increases uptake

“…Similar strategies have been implemented in more common malignancies, such as breast and colorectal cancer, and have increased the rates of germline testing in those conditions as well [9,18]. However, differences in the quality of pre-test counseling provided by oncology staff compared to genetic counselors have been detected [19]. In our study, an educational video was utilized to address this gap, as automation of components of pre-test counseling has been previously shown to improve patient knowledge of germline testing and feelings of empowerment [20].…”

Mainstream genetic testing for women with ovarian cancer provides a solid basis for patients to make a well-informed decision about genetic testing

“…We compared these outcomes to those of a control group receiving standard genetic care (pre-test counseling performed by a genetic counselor or clinical geneticist). So far, only four previous studies have evaluated genetic care of patients receiving mainstreamed genetic care in direct comparison to a valid control group, and for the majority with a limited number of patients in these groups [16,[18][19][20].…”

“…Many studies have shown high acceptability of mainstream genetic testing approaches among EOC patients [5,6,[15][16][17][18][19][20][21]. So far, these outcomes have only been evaluated sporadically with a control group receiving pre-test genetic counseling at a genetics department [16,[18][19][20].…”

“…Many studies have shown high acceptability of mainstream genetic testing approaches among EOC patients [5,6,[15][16][17][18][19][20][21]. So far, these outcomes have only been evaluated sporadically with a control group receiving pre-test genetic counseling at a genetics department [16,[18][19][20]. Two of these studies included both patients with breast and ovarian cancer, and post-test counseling was always performed by a genetic counselor or clinical geneticist [16,19].…”

“…So far, these outcomes have only been evaluated sporadically with a control group receiving pre-test genetic counseling at a genetics department [16,[18][19][20]. Two of these studies included both patients with breast and ovarian cancer, and post-test counseling was always performed by a genetic counselor or clinical geneticist [16,19]. Another study predominantly considered patient satisfaction [18].…”