Incorporating genomics into routine clinical care for Veterans with colon cancer

将基因组学纳入退伍军人结肠癌常规临床护理 项目摘要 退伍军人健康护理的预期影响：基因组学为早期发现和护理提供信息 结肠癌是首批积累起来的个性化药物应用之一。 临床实用性和有效性的充分证据。我们提议的工作的发现将 向退伍军人健康管理局(VHA)通报 基因组学在VHA照顾的结肠癌退伍军人常规临床实践中的应用。我们的 该项目将为改善VHA中这些服务的交付提供新的见解。 背景：虽然VHA已经认识到它在服务于国家的前列的潜力 基因组医学，并选择遗传性非息肉病性结肠癌(HNPCC)作为 最初的焦点是临床试验，关于基因组传递的信息很少 为被诊断患有结肠癌的退伍军人提供服务，他们在VHA得到照顾。当前 有证据支持对所有被诊断为结肠癌的退伍军人使用基因组服务 对于50岁以下的人和许多被诊断在50岁到60岁之间的人来说。 需要关于向这些退伍军人提供基因组服务的当前模式的信息 在VHA中得到照顾(即，家族史评估、遗传咨询、分子分析、 和基因测试)以及临床医生在提供这些服务时遇到的障碍 在适合退伍军人的情况下。 目标：我们的最终目标是向VHA通报交付的最佳模式 结肠癌临床环境中的基因组健康服务。因此，我们的具体目标是： 1)描述目前退伍军人结肠癌护理的模式，这些模式由 基因组信息，以及2)检查整合基因组的障碍和促进者 为确诊为结肠癌的退伍军人提供常规护理的信息和服务。 方法：我们将采用定量和定性相结合的方法。 完成我们的特定目标。为了解决具体目标一，我们将对三个主要数据进行三角测量 描述当前服务提供模式的来源。这些将包括VHA和其他 管理数据、VHA癌症登记处和病历摘要数据。致信地址 具体目标二，我们将从VHA设施的全国样本中采访关键线人 结肠癌临床环境中基因组服务提供的障碍和促进者。钥匙 告密者将是VHA临床医生和参与结肠癌筛查的管理人员， 诊断和治疗，包括胃肠病医生、肿瘤学家、病理学家、肿瘤委员会 成员、护士、癌症登记工作人员和实验室管理人员。

Incorporating genomics into routine clinical care for Veterans with colon cancer Project Summary Anticipated impacts for VA Health Care: Genomics to inform early detection of and care for colon cancer is among the first applications of personalized medicine to have accumulated substantial evidence of clinical utility and validity. The findings from our proposed work will inform the Veterans Health Administration (VHA) about the current level of integration of genomics in routine clinical practice for Veterans with colon cancer cared for in the VHA. Our project will provide new insights about improving the delivery of these services in the VHA. Background: While the VHA has recognized its potential to serve the nation at the forefront of genomic medicine and has selected hereditary nonpolyposis colon cancer (HNPCC) as the initial focus for clinical trials, there is little information available on the delivery of genomic services to Veterans diagnosed with colon cancer who are cared for in the VHA. Current evidence supports the use of genomic services for all Veterans diagnosed with colon cancer who are under age 50 and for many who are diagnosed between the ages of 50 and 60. Information is needed on current patterns of delivery of genomic services to these Veterans cared for in the VHA (i.e., family history assessment, genetic counseling, molecular analysis, and genetic testing) and on the barriers encountered by clinicians to providing these services when appropriate to Veterans. Objectives: Our ultimate goal is to inform the VHA about the best models for the delivery of genomic health services in the colon cancer clinical setting. Accordingly, our specific aims are: 1) to characterize the current patterns of colon cancer care for Veterans that are informed by genomic information, and 2) to examine the barriers to and facilitators of incorporating genomic information and services into routine care for Veterans diagnosed with colon cancer. Methods: We will use mixed methods including quantitative and qualitative approaches to accomplish our specific aims. To address specific aim one, we will triangulate three main data sources to characterize current patterns of service delivery. These will include VHA and other administrative data, the VHA Cancer Registry, and medical record abstraction data. To address specific aim two, we will interview key informants from a national sample of VHA facilities about barriers and facilitators of genomic service delivery in the colon cancer clinical setting. Key informants will be VHA clinicians and administrators involved in colon cancer screening, diagnosis, and treatment, including gastroenterologists, oncologists, pathologists, tumor board members, nurses, cancer registry staff, and laboratory administrators.