Virtual Cancer Genetic Services: Telemedicine Delivery in Community Clinics

描述（由申请人提供）：基因组学的基础科学进步为改善人类健康和减轻美国癌症负担提供了巨大的希望，推动了个性化医疗领域的快速发展。然而，将基因发现转化为有利于个人和人群健康的负责任和有效的应用存在许多挑战。癌症易感性基因筛查是“个性化医疗”的一种应用，已成为临床医学的标准护理。鉴于对基因检测的需求日益增加以及广泛传播服务以优化人口健康效益的愿望，目前肿瘤基因检测的提供模式对基因检测的广泛传播构成了障碍。远程医疗（例如视频会议）已成功地用于将各种专门医疗服务扩大到低机会人口。然而，我们对远程医疗在个人和人群层面上的影响的理解存在重大差距。需要进一步研究制定和评估远程医疗通信、交付和传播策略，以优化远程医疗遗传服务的结果，包括癌症遗传学和其他领域。癌症遗传服务的传播为评估远程医疗提供癌症遗传服务的传播，以及评估和了解个性化医疗在不同人群中的现实结果提供了理想的环境。我们建议开发一种远程医疗（即视频会议）提供癌症遗传服务的协议，并评估在有限或没有现场访问的社区临床实践中实施该协议的可行性

DESCRIPTION (provided by applicant): Basic science advances in genomics have provided great promise for improving human health and reducing the burden of cancer in the United States, fueling the rapidly growing field of personalized medicine. Yet, translating gene discoveries into responsible and effective applications that benefit the health of individuals and populations presents many challenges. Genetic screening for cancer susceptibility is one application of "personalized medicine", which has become standard of care in clinical medicine. Given the increasing demand for genetic testing and the desire to disseminate services broadly to optimize population health benefits, the current delivery model for genetic testing in oncology presents barriers to widespread dissemination of genetic testing. Telemedicine (e.g. videoconferencing) has been successfully used to expand a variety of specialized medical services to low access populations. Yet, there are significant gaps in our understanding of the impact of telemedicine at both individual and population levels. Further research is needed to develop and evaluate telemedicine communication, delivery, and dissemination strategies to optimize outcomes of telemedicine genetic services, in and beyond cancer genetics. The diffusion of cancer genetic services provides an ideal context to evaluate the dissemination of telemedicine delivery of cancer genetic services, and to assess and understand the real world outcomes of personalized medicine in diverse populations. We propose to develop a protocol for telemedicine (i.e. videoconferencing) delivery of cancer genetic services, and evaluate the feasibility of implementing it in community clinical practices with limited or no access to on-site genetic services, expanding the availability of personalized cancer risk assessment to populations where access to services has been limited or is associated with significant barriers to utilization. In Aim 1, we will collaborate with community practices to develop and pilot a protocol for telemedicine cancer genetic services for community practices with limited or no access to genetic services. In the pilot, we will use providers (genetic providers & community site staff) and patient surveys to refine the telemedicine protocol and procedures. In Aim 2, we will conduct semi-structured interviews with key practice stakeholders from 10-12 additional community practices to identify variables critical to the sustainable adoption and implementation of our telemedicine protocol in diverse clinical community practices with limited or no access to genetic services. We expect this research to inform future efficacy and effectiveness research focused on broader implementation of, and sustainability telemedicine cancer genetic services in community practices. Additionally, we expect this research to inform the dissemination of other emerging and new applications of personalized medicine, fostering the translation of research to clinical practice, and promoting the health of individuals, families and populations. PUBLIC HEALTH RELEVANCE: As the diversity and volume of genomic testing increases, translational research that evaluates the dissemination and real-world outcomes of existing and new genomic applications is needed to guide the rational and effective clinical integration of genomic advances that will ultimately reduce the burden of cancer and other prevalent diseases, to improve human health. Telemedicine delivery of genetic services in community practices is an innovative delivery model that has the potential to expand availability of personalized cancer risk assessment to populations where access to services has been limited or is associated with significant geographic or financial barriers to utilization. Thus, this reseach has the potential to foster the translation of basic science research to clinical practice, promotig the health of individuals, families, and thus populations.