Evaluating and improving the implementation of a community-based hereditary cancer screening program

Abstract

Healthcare disparities exist in the provision of cancer genetic services including genetic counseling and testing related to BRCA1/2 mutations. To address this in a community health setting a screening tool was created to identify high-risk women. This study evaluates the implementation of the tool and identifies opportunities for improved cancer genetic screening, including regular clinician education. A mixed-method approach was used to evaluate clinician utilization of the screening tool at Planned Parenthood affiliates. Novel surveys that evaluated acceptance and implementation were administered to clinicians (n = 14) and semi-structured interviews (n = 6) were used to explore clinicians' perspectives and identify gaps in its utilization. Educational modules that addressed gaps were developed, implemented, and evaluated using a post-education survey (n = 8). Clinicians reported confidence in administering and interpreting the screening tool, but reported less confidence in their knowledge of cancer genetics and ability to connect clients with genetic counseling and testing (p = .003). Educational modules resulted in significant gains in clinician knowledge on genetic topics (p < .05) and increased self-reported confidence in connecting clients with genetic services. The modules reinforced the belief that genetic testing is beneficial for patients at increased risk (p = .001) and is important to inform subsequent medical management (p = .027). While building community clinicians' capacity to connect clients with genetic services is crucial, it is challenged by knowledge and confidence gaps in discussions of genetic services with clients. Consistent genetic-focused education with non-genetic clinicians can improve confidence and knowledge, enabling a more effective screening program in community health settings.

Adapting genetic counseling operations amidst the COVID‐19 pandemic

“…Telegenetics appointments were well received by patients and reduced barriers of conventional in‐person genetic counseling appointments such as lack of transportation, childcare, or time off work (Cohen et al., 2016 ; Greenberg et al., 2019 ; Hilgart et al., 2012 ; Joseph & Guerra, 2014 ; Joseph et al., 2017 ; Kinney et al., 2010 ; Komenaka et al., 2015 ; McCarthy et al., 2016 ; Rana et al., 2018 ; Sherman et al., 2013 ). Increased accessibility of genetic services is especially important among underserved populations, and data from the CH patient population demonstrated that telephone consultations are an effective and potentially more successful means of reaching these patients for genetic counseling.…”

Leveraging Implementation Science to Address Health Disparities in Genomic Medicine: Examples from the Field

“…From this, an education module was developed to improve clinician knowledge of cancer genetics and self-efficacy for connecting clients to genetic counseling and testing for HBOC; this module was then implemented and evaluated. 48 In the end, the education module was effective in improving knowledge and confidence among clinicians. Using implementation frameworks, 34 strategies 49 and measures 50 will further strengthen health disparities research in genomics, by providing standardized metrics and strategies for assessing use of genomic medicine across clinical and public health settings.…”

Untitled

“…Racial minority populations in the United States are disproportionately affected by these healthcare disparities (73). Consistent with these findings, multiple studies have documented disparities in access to genetic services for low-income and minority patients (36,53,63,65,69,119,126). Barriers include limitations in physicians' genetics knowledge, use of genetic testing, and referral to genetic services; availability and cost of services; lack of translation services; and failure of appropriate follow-up after testing or referral occurs.…”

“…Barriers include limitations in physicians' genetics knowledge, use of genetic testing, and referral to genetic services; availability and cost of services; lack of translation services; and failure of appropriate follow-up after testing or referral occurs. Although clinic-based interventions can improve genetic assessment and referral rates (63,69), many of the barriers reflect underlying social determinants that constrain patient options (53).…”