A single visit multidisciplinary model for managing patients with mutations in moderate and high-risk genes in a community practice setting

Abstract

The introduction of screening for multiple high and moderate risk mutations in genes has resulted in a complex approach to patient care involving multiple disciplines. We sought to describe the feasibility of a single visit multidisciplinary approach to the management of patients with an identified high/moderate risk gene mutation. Patients who presented to our community hospital over a 1-year period who were found to have a high/moderate risk genetic mutation on a screening panel were referred to the High Risk Genetic Clinic. Thirty-five patients were included. The majority were female [34 (97.1%)], Hispanic [22 (62.9%)], with a family history of cancer [21 (60%)]. Mean age was 40.3 years. Most of the participants had a BRCA1 gene mutation [10 (28.6%)]. Patients were seen at the High Risk Genetic Clinic within a mean of 41.9 days from the day of genetic mutation diagnosis. Four patients did not show and were significantly younger (19.3 vs. 39.6 years, p = 0.014). In this community setting, we provided coordinated care within multiple disciplines related to a genetic mutation in a single clinic visit. Increased efforts at coordinating early care should be directed towards patients diagnosed at a younger age.

Systemic Barriers to Risk-Reducing Interventions for Hereditary Cancer Syndromes: Implications for Health Care Inequities

“…Interventions that interact with clinician-level factors, such as ongoing clinician education, are less likely to reach medically underserved patients, who have less access to specialty clinicians and academic medical centers, where these interventions are most often implemented. Similarly, although multidisciplinary clinics can improve care coordination, 77,78 they are resource-intensive and require significant patient volume to justify. Therefore, they may not be feasible in low-resource settings or rural settings with a low number of affected individuals.…”

“…To simplify the process of tracking and coordinating the numerous recommended surveillance and surgical procedures, some studies have explored the use of one-stopshop multidisciplinary clinics, where patients can visit multiple specialists and undergo multiple surveillance procedures on the same day in a single location. 77,78 Such models have shown improved adherence to guidelinerecommended care and high patient uptake. 77,78 At least one of these clinics has shown preliminary success in a community-based practice setting and with patients of predominantly Hispanic ethnicity, with 80% of patients (28 of 35) attending their first visit and receiving consultations with genetics clinicians, social workers, and/or relevant surgeons.…”

“…77,78 Such models have shown improved adherence to guidelinerecommended care and high patient uptake. 77,78 At least one of these clinics has shown preliminary success in a community-based practice setting and with patients of predominantly Hispanic ethnicity, with 80% of patients (28 of 35) attending their first visit and receiving consultations with genetics clinicians, social workers, and/or relevant surgeons. 77 Multidisciplinary clinics may also help patients with limited resources overcome scheduling and transportation barriers by streamlining care.…”