A systematic review of communication interventions to help healthcare professionals discuss genetic testing for breast cancer

Abstract

Purpose This systematic review examined educational training interventions for healthcare professionals (HCPs) discussing genetic testing and risk for hereditary breast cancer. There was a particular focus on the presence, and content, of communication elements within these packages. Methods Searches were run via CINAHL, EMBASE, PUBMED, and PsychInfo in February 2019 to identify training interventions available to HCPs with reference to communication skills. Studies were assessed for quality, with relevant intervention and outcome data extracted and synthesized. This review followed the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) statement and was registered on the PROSPERO database (CRD42019124010). Results Of 3,988 items, seven papers, two of which were linked, were eligible for inclusion. There was a mix of randomized and single arm studies with web-based and face-to-face interventions. Content included an overview of genetics, hereditary and familial background, and recommended practice techniques. Outcomes focused on communication, self-efficacy, knowledge, and satisfaction. Interventions were designed for genetic counselors, physicians, primary care physicians (PCPs), medical students, and nurses. None of the papers featured oncologists or surgeons. Conclusions This review revealed an overall lack of publications which evaluated interventions to assist HCPs discussing hereditary breast cancer risk and testing. Studies failed to operationalize which 'communication skills' they included, nor did they consistently report randomization, outcome measures, or analysis. Discussing the need for, and management of, genetic testing for inherited cancer risk with individuals and their families can be challenging. As genetic testing in breast cancer becomes more common, the provision of specific communication-based training programs, with reference to genetic testing, risk assessments, and counseling skills is warranted.

The Feasibility of Implementing Mainstream Germline Genetic Testing in Routine Cancer Care—A Systematic Review

“…Several modules have been developed to train healthcare professionals in how to provide counseling regarding hereditary diseases [ 40 , 41 ]. Many of these have been developed for NGHCPs and they mainly focus on attitudes about counseling, communication skills and knowledge.…”

Talking about Risk, UncertaintieS of Testing IN Genetics (TRUSTING): development and evaluation of an educational programme for healthcare professionals about BRCA1 & BRCA2 testing

“…Educational programmes designed to improve communication may fail to change behaviours effectively if the methods used or the contents of them are inappropriate. Our systematic review conducted prior to the development of TRUSTING revealed that there were few publications evaluating interventions explicitly designed to help HCPs discussing hereditary breast cancer risk and testing and that most failed to operationalise the skills that were included, outcome measures or analysis [12]. More recently, an influential report on the guidelines for genomics education has been published which might assist future programme developers [25].…”

“…During Phase 1, we conducted a systematic review of all relevant communication skills training programmes dealing with the genetic testing of high-risk breast cancer patients. We determined their content, methods of delivery, how outcomes had been measured and how successful programmes had been [ 12 ].…”

General practitioners’ (GPs) experience, attitudes and needs on clinical genetic services: a systematic review

“…Existing reviews mostly examine cancer genetics5–10 with the most recent review that focused on general clinical genetics published in 2016 11. Existing reviews have found that GPs experienced a lack of knowledge and confidence in basic genetics and risk assessments in the provision of clinical genetic services 5 7 8 12 13.…”

“…However, little is known about whether existing educational initiatives and clinical interventions has changed GPs’ experience and attitudes towards the adoption of clinical genetics. Also, most reviews focusing on primary care mostly included specialists such as oncologists, genetic counsellors, paediatricians and allied health professionals in their study population 5–8 10 12 13. While alike, specialists would yield different experience as practice styles are heterogeneous 14.…”