Community Cancer Genetics and Research Training (Revision)

描述（由申请人提供）：熟练的癌症风险咨询师和癌症预防和控制研究是迫切需要的，以提高对确定有遗传癌症易感性的个体可用的管理选择的效力和范围。与大多数其他临床服务相比，癌症风险评估涉及更多的步骤和提供者时间，并已成为一门高度专业化的学科。从业人员水平的能力在癌症风险评估是由先进的技能，包括能力：产生扩大的鉴别诊断；确定个体化癌症风险（遗传和/或经验）；提供量身定制的风险管理建议；并确定潜在的研究资格。大多数以社区为基础的癌症遗传学从业者没有足够的技能或机会参与研究。这些技能的综合还没有在医学院的课程、遗传咨询或护理培训项目中得到充分的阐述。临床癌症遗传学服务曾经是学术健康中心的专属领域，现在越来越多地在社区环境中提供。因此，大量潜在的临床研究课题可能无法实现。2005年NCI旁路预算强调了癌症沟通和策略的重要性，以解决与癌症易感性相关的临床、行为和社会问题（NIH出版物No. 03-5446）。该文件指出，必须促进网络、伙伴关系和联盟，将研究成果转化为临床实践和公共卫生惠益。然而，到目前为止，还没有针对社区临床医生的临床癌症遗传学和研究合作的强化培训项目。

DESCRIPTION (provided by applicant): Skilled cancer risk counselors and cancer prevention and control studies are critically needed to improve the efficacy and range of management options available to individuals identified to have a genetic cancer predisposition. Cancer risk assessment involves more steps and provider time than most other clinical services, and has emerged as a highly specialized discipline. Practitioner- level competence in cancer risk assessment is marked by advanced skills, including the ability to: generate expanded differential diagnoses; determine individualized cancer risk (genetic and/or empiric); provide tailored risk management recommendations; and identify potential research study eligibility. Most community-based cancer genetics practitioners do not have adequate skills or opportunity to participate in research. The composite of these skills is not yet fully addressed in the curricula of medical school, genetic counseling or nursing training programs. Once the exclusive domain of academic health centers, clinical cancer genetics services are increasingly being delivered in community settings. Consequently, a substantial number of potential clinical research subjects may not be realized. The NCI bypass budget for 2005 highlights the importance of cancer communications and strategies to address the clinical, behavioral and societal issues associated with cancer susceptibility (NIH Publication No. 03-5446). The document notes the importance of promoting networks, partnerships and coalitions to translate the results of research into clinical practice and public health benefit. However, to date there are no intensive training programs in clinical cancer genetics and research collaboration for community-based clinicians. Recently published outcomes from a pilot course demonstrated significant improvement in cancer genetics knowledge for participants (p>0.001), and a needs assessment survey demonstrated continued need for education in the target populations, and research collaboration interest and efforts by pilot course alumni suggested the feasibility of using a course to promote participation in research activities. Therefore, we propose to develop a multi-modal, interdisciplinary course to confer practitioner-level competence in cancer risk assessment, and skills to promote research participation in a community setting. The program will provide approximately 60 hours of prescribed didactic and interactive instruction, twelve months of continued practice development via web-conferencing and long-term access to a web board for asynchronous learning. The program design is novel, uses multiple synchronous and asynchronous teaching modalities to maximize learning, and is flexible to accommodate the needs of participants with varied training backgrounds and practice settings. The impact of the course on participant knowledge, skills, changes in practice, and research participation will be measured. Long-term objectives of the project are to increase community access to competent cancer genetics services, and to increase accrual of high-risk patients into research protocols. The curriculum and delivery design may serve as a model for dissemination to other cancer centers to help address NCI priorities such as augmentation of familial registries (e.g. Cooperative Family Studies)