Reducing Disparities in Receipt of Genetic Counseling for Underserved Women at Risk of Hereditary Breast and Ovarian Cancer

Patient and Clinician Decision Support to Increase Genetic Counseling for Hereditary Breast and Ovarian Cancer Syndrome in Primary Care

“… 28 , 33 , 34 , 71 Even after a referral, genetic counseling remains underutilized and disparities with respect to uptake exist. 72 In a study of 72 women with low income screened for family history, Pasick et al 73 found only 4.5% uptake of a free genetic counseling session when patients were asked to schedule the appointment themselves. This finding suggests that removing cost barriers may be insufficient to maximize uptake of genetic counseling.…”

“…Clinician recommendation is often the first step toward uptake of genetic counseling, but a referral is less likely to occur among women in minoritized racial and ethnic groups and with patients with a lower level of education and limited health literacy . Even after a referral, genetic counseling remains underutilized and disparities with respect to uptake exist . In a study of 72 women with low income screened for family history, Pasick et al found only 4.5% uptake of a free genetic counseling session when patients were asked to schedule the appointment themselves.…”

Do current family history-based genetic testing guidelines contribute to breast cancer health inequities?

“…We also offer that the routine offering of multigene panel testing is a system-level factor whereas the uptake of counseling and genetic testing is an individual-level factor. For example, in an urban academic medical center, medical records were reviewed from 2016-2017 for women who were referred to a genetic counselor for hereditary breast and ovarian cancer 51 . The study found no racial difference in making a genetic counseling appointment or keeping the genetic counseling appointment.…”

Measuring quality and value in genetic counseling: The current landscape and future directions

“…Another example is equity, which has been explored by many research studies and addressed by quality improvement efforts in the clinical setting. Research on this topic has examined access to and uptake of genetic services (Bellaiche et al, 2021; Sutton et al, 2020; Uhlmann et al, 2021), availability of services and resources in a range of languages and literacy levels (Augusto et al, 2019; Hurtado‐de‐Mendoza et al, 2019; Kamara et al, 2018; Vadaparampil et al, 2021), and financial barriers (Brown et al, 2019; Erwin et al, 2020; Lin et al, 2021) among other things. Having quality measures for equity would allow standardization of efforts and a means to document improvements.…”