A Comprehensive Program Enabling Effective Delivery of Regional Genetic Counseling
A Comprehensive Program Enabling Effective Delivery of Regional Genetic Counseling
复制标题
DOI：
10.1097/igc.0000000000001256
复制
发表时间：
2018-06-01
影响因子：
4.8
通讯作者：
Amacker-North, Lisa
中科院分区：
文献类型：
--
作者：
Brown, Jubilee;Athens, Aly;Amacker-North, Lisa
目的本研究的目的是展示一个综合计划的效用，该计划包括基于管理的证据、远程医疗和患者导航，以在一个地理上庞大的医疗保健系统中为卵巢癌和乳腺癌患者提供遗传咨询服务。结果自该项目实施以来，卵巢癌新发病例数保持不变(109-112例/年)，而转诊遗传咨询者从37%上升到43%到96%(P<；0.05)。卵巢癌患者接受基因检测的比例每年从24%上升到27%到53%(P<；0.05)。新发乳腺癌患者数量保持不变(1543-1638例/年)。接受遗传咨询的三阴性乳腺癌患者的转介比例从2013年的69%上升到2015年的91%；接受检测的患者比例每年从59%上升到86%(P<；0.05)。在45岁以下确诊的乳腺癌患者中，78%至85%的患者在此期间被转介接受遗传咨询；接受检测的患者比例每年从66%增加到82%(P<；0.05)。在此期间，启动了患者导航，并对系统中的所有患者可用。118例(6%)的乳房/卵巢患者接受了远程医疗咨询。结论综合计划可以改善卵巢癌和乳腺癌患者获得有效遗传咨询服务的机会，而不受地域的限制。
Objectives The aim of this study was to demonstrate the utility of a comprehensive program involving management-based evidence, telemedicine, and patient navigation to provide genetic counseling services for patients with ovarian and breast cancer across a geographically large health care system.Methods We identified all patients with newly diagnosed ovarian and breast cancer in our health care system from January 2013 to December 2015 through the cancer registry. Referral characteristics and testing outcomes were recorded for each year and compared using the (2) or Fisher exact test.Results Because the implementation of this program, the number of new ovarian cancer cases remained constant (109-112 cases/year) but patients referred for genetic counseling increased annually from 37% to 43% to 96% (P < 0.05). The percentage of ovarian cancer patients who underwent genetic testing increased annually from 24% to 27% to 53% (P < 0.05). The number of new breast cancer patients was constant (1543-1638 cases/year). The percentage of patients with triple negative breast cancer referred for genetic counseling rose from 69% in 2013 to 91% in 2015; the percentage of patients who underwent testing increased annually from 59% to 86% (P < 0.05). Of women with breast cancer diagnosed at less than 45 years of age, 78% to 85% were referred for genetic counseling across this period; the percentage of patients who underwent testing increased annually from 66% to 82% (P < 0.05). Patient navigation was initiated and was available to all patients in the system during this period. Telemedicine consults were performed in 118 breast/ovarian patients (6%) during this period.Conclusions A comprehensive program may improve access to effective genetic counseling services in patients with ovarian and breast cancer despite geographic barriers.