Increase in Genetic Counseling and Testing Referrals After Breast Cancer Pathway Implementation

Abstract

<jats:sec><jats:title>PURPOSE:</jats:title><jats:p> Genetic counseling and testing (GC/T) for breast cancer–associated genetic mutations are important components in the appropriate management of newly diagnosed breast cancer. We initiated pathways to help appropriately select patients who meet criteria for GC/T referral (GC/T-R) across the Sarah Cannon Cancer Institute Network. This study evaluated physician pathway training as a means to improve access to GC/T-R. </jats:p></jats:sec><jats:sec><jats:title>METHODS:</jats:title><jats:p> In this retrospective, observational study, we collected data from 7 regions across 6 states, identifying 3,113 patients eligible for GC/T. Patients were divided into 3 defined cohorts: patients treated before implementation of pathways (n = 988), patients treated by non-pathway physicians after pathways were established (n = 1,094), and patients treated by pathway-trained physicians (n = 1,031). Pathways were established in March 2016. Nurse navigators documented eligible patients who were referred for GC/T within a care coordination software system. </jats:p></jats:sec><jats:sec><jats:title>RESULTS:</jats:title><jats:p> Eligible patients were referred for GC/T 71.77% of the time if treated on pathways and only 36.47% of the time if treated off pathways. On-pathway patients eligible for GC/T also received testing referral at a higher rate than pre-pathway patients (21.36%). </jats:p></jats:sec><jats:sec><jats:title>CONCLUSION:</jats:title><jats:p> After implementation of pathways and appropriate training of physicians on those pathways, GC/T-R among appropriate patients significantly improved. Pathway training represents a potential solution to improve GC/T-R among patients with breast cancer. </jats:p></jats:sec>

Maximizing cancer prevention through genetic navigation for Lynch syndrome detection in women with newly diagnosed endometrial and nonserous/nonmucinous epithelial ovarian cancer

“…They are trained by certified genetic counselors to play roles similar to that of the genetic navigator in our study; these individuals were able to increase patient access to genetic services by a factor of 4 in the context of BRCA1/2 genetic testing 25 . Other programs have focused on training physicians or implementing “mainstreaming,” in which specialties other than genetics can initiate the testing 34 . The problems with these previous strategies lie in the fact that they attempt to address 1 main barrier rather than addressing the multifaceted barriers as described in the literature.…”

“… 25 Other programs have focused on training physicians or implementing “mainstreaming,” in which specialties other than genetics can initiate the testing. 34 The problems with these previous strategies lie in the fact that they attempt to address 1 main barrier rather than addressing the multifaceted barriers as described in the literature. By addressing systems‐related, participant‐related, and care provider–related barriers, our multipronged approach significantly increased the rate of genetic counseling to 91% and the rate of genetic testing to 100%, rates that are unprecedented in comparison with those reported previously.…”

The design, implementation, and effectiveness of intervention strategies aimed at improving genetic referral practices: a systematic review of the literature

“…Eight studies [3,[35][36][37][38][39][40][41] conducted preimplementation meetings among stakeholder workgroups to plan the improvement effort and allow intervention refinement. Other preimplementation strategies included identifying and preparing local champions [39,41,42], conducting educational meetings about the intervention [40,[43][44][45], involving executive boards [3,41], developing a formal implementation blueprint [40], and forming partnerships with implementation experts [3]. Interventions were designed by end users in five studies [33,34,[37][38][39], while five studies used a codesign approach with collaboration between researchers and end users [3,36,40,46,47].…”

“…The remaining 22 studies did not specify the approach to intervention design. Mid-implementation strategies included the provision of ongoing researcher support to promote intervention uptake [40,44], tailoring of strategies based on clinician experiences [36,43], and provision of auditing feedback on intervention adherence [45]. No postimplementation strategies were identified.…”

Implementation and outcome evaluations of a multi‐site improvement program in cancer genetics

“…Single‐institution efforts have successfully applied process standards and quality improvement (QI) methods to increase patient receipt of guideline‐recommended cancer genetic counseling and germline genetic testing, however intentional dissemination and implementation of successful efforts in external clinical settings have not been widely reported (Bednar et al, 2017; Bednar et al, 2019; Graff et al, 2020; Swanson et al, 2018; Uyar et al, 2018). Efforts to improve patient access to guideline‐based cancer genetics services are well positioned for dissemination and implementation, and the application of existing approaches from social sciences and public health fields are needed to ensure the appropriate design and evaluation of evidence‐based, patient‐centered programs (National Academies of Sciences, 2016).…”