Incorporating genomics into routine clinical care for Veterans with colon cancer

将基因组学纳入结肠癌退伍军人的常规临床护理 项目摘要 对VA医疗保健的预期影响：基因组学为早期发现和护理提供信息 结肠癌是个人化医疗的第一批应用， 临床实用性和有效性的实质性证据。从我们的拟议工作中得出的结果将 通知退伍军人健康管理局（VHA）关于目前的整合水平， 基因组学在常规临床实践中的退伍军人与结肠癌照顾的VHA。我们 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已经认识到其在最前沿服务国家的潜力， 基因组医学，并选择遗传性非息肉病性结肠癌（HNPCC）作为 由于临床试验的最初重点，关于基因组药物递送的信息很少。 为被诊断患有结肠癌的退伍军人提供服务，他们在VHA接受护理。电流 有证据支持所有被诊断患有结肠癌的退伍军人使用基因组服务 年龄在50岁以下的人，以及许多年龄在50至60岁之间的人。 需要了解目前向这些退伍军人提供基因组服务的模式 在VHA中护理（即，家族史评估，遗传咨询，分子分析， 以及临床医生在提供这些服务时遇到的障碍 适合退伍军人。 目标：我们的最终目标是向VHA提供关于交付 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)描述退伍军人结肠癌护理的当前模式， 基因组信息，以及2）检查整合基因组信息的障碍和促进因素 信息和服务纳入常规护理的退伍军人诊断为结肠癌。 方法：我们将使用混合方法，包括定量和定性方法， 实现我们的具体目标。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 资料来源，以说明目前提供服务的模式。其中包括VHA和其他 管理数据、VHA癌症登记处和病历摘要数据。解决 具体目标二，我们将采访来自VHA设施的国家样本的关键线人， 结肠癌临床环境中基因组服务提供的障碍和促进因素。关键 知情者将是参与结肠癌筛查的VHA临床医生和管理人员， 诊断和治疗，包括胃肠病学家、肿瘤学家、病理学家、肿瘤委员会 成员、护士、癌症登记处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.