Clinical implementation of an oncology-specific family health history risk assessment tool.

Autor: Fung SM; Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore., Wu RR; Centre for Applied Genomics and Precision Medicine, Department of Medicine, Duke University School of Medicine, 304 Research Dr. Box 90141, Office 264, North Carolina, 27708, Durham, USA. ryanne.wu@duke.edu.; Department of Medicine, Duke University School of Medicine, 304 Research Dr. Box 90141, Office 264, North Carolina, 27708, Durham, USA. ryanne.wu@duke.edu.; Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore. ryanne.wu@duke.edu., Myers RA; Centre for Applied Genomics and Precision Medicine, Department of Medicine, Duke University School of Medicine, 304 Research Dr. Box 90141, Office 264, North Carolina, 27708, Durham, USA., Goh J; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore., Ginsburg GS; Centre for Applied Genomics and Precision Medicine, Department of Medicine, Duke University School of Medicine, 304 Research Dr. Box 90141, Office 264, North Carolina, 27708, Durham, USA.; Department of Medicine, Duke University School of Medicine, 304 Research Dr. Box 90141, Office 264, North Carolina, 27708, Durham, USA., Matchar D; Department of Medicine, Duke University School of Medicine, 304 Research Dr. Box 90141, Office 264, North Carolina, 27708, Durham, USA.; Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore., Orlando LA; Centre for Applied Genomics and Precision Medicine, Department of Medicine, Duke University School of Medicine, 304 Research Dr. Box 90141, Office 264, North Carolina, 27708, Durham, USA.; Department of Medicine, Duke University School of Medicine, 304 Research Dr. Box 90141, Office 264, North Carolina, 27708, Durham, USA., Ngeow J; Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore.; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
Jazyk: angličtina
Zdroj: Hereditary cancer in clinical practice [Hered Cancer Clin Pract] 2021 Mar 20; Vol. 19 (1), pp. 20. Date of Electronic Publication: 2021 Mar 20.
DOI: 10.1186/s13053-021-00177-y
Abstrakt: Background: The presence of hereditary cancer syndromes in cancer patients can have an impact on current clinical care and post-treatment prevention and surveillance measures. Several barriers inhibit identification of hereditary cancer syndromes in routine practice. This paper describes the impact of using a patient-facing family health history risk assessment platform on the identification and referral of breast cancer patients to genetic counselling services.
Methods: This was a hybrid implementation-effectiveness study completed in breast cancer clinics. English-literate patients not previously referred for genetic counselling and/or gone through genetic testing were offered enrollment. Consented participants were provided educational materials on family health history collection, entered their family health history into the platform and completed a satisfaction survey. Upon completion, participants and their clinicians were given personalized risk reports. Chart abstraction was done to identify actions taken by patients, providers and genetic counsellors.
Results: Of 195 patients approached, 102 consented and completed the study (mean age 55.7, 100 % women). Sixty-six (65 %) met guideline criteria for genetic counseling of which 24 (36 %) were referred for genetic counseling. Of those referred, 13 (54 %) participants attended and eight (33 %) completed genetic testing. On multivariate logistic regression, referral was not associated with age, cancer stage, or race but was associated with clinical provider (p = 0.041). Most providers (71 %) had higher referral rates during the study compared to prior. The majority of participants found the experience useful (84 %), were more aware of their health risks (83 %), and were likely to recommend using a patient-facing platform to others (69 %).
Conclusions: 65 % of patients attending breast cancer clinics in this study are at-risk for hereditary conditions based on current guidelines. Using a patient-facing risk assessment platform enhances the ability to identify these patients systematically and with widespread acceptability and recognized value by patients. As only a third of at-risk participants received referrals for genetic counseling, further understanding barriers to referral is needed to optimize hereditary risk assessment in oncology practices.
Trial Registration: NIH Clinical Trials registry, NCT04639934 . Registered Nov 23, 2020 -- Retrospectively registered.
Databáze: MEDLINE
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