Characterization of genetic counselor practices in inpatient care settings

Abstract

Rapid genomic testing is increasingly used in inpatient settings for diagnostic and treatment purposes. With the expansion of genetic testing in this setting, requests for inpatient genetics consultations have increased. There have been reports of genetic counselors working in inpatient care, though their specific roles are not well described. In this study, we characterized the roles of genetic counselors practicing in inpatient care settings in the United States and Canada. Genetic counselors were recruited via professional organization listservs to complete an online survey. The survey gathered information on participants' roles and workflow of inpatient genetics consultation services at their institution. Responses from 132 participants demonstrate that 50.4% of genetic counselors cover genetics consultations as needed or on a rotating schedule (34.6%). They practice in general pediatric (59.1%), neonatal (42.5%), cancer (28.3%), and/or prenatal (18.9%) specialties, among others. Participants reported working independently (16.1%) or with other providers (54.8%), including geneticists and other attending physicians. The workflow of genetics consultation services varies between institutions in the delivery of consults, members of the inpatient genetics consultation care team, and administrative support. Fifty percent of participants reported having no exposure to inpatients during graduate training, and 87.3% of participants reported receiving no institutional training for their inpatient role. This is the first study to describe roles of genetic counselors in inpatient care. It establishes a foundation for future research on inpatient genetic counseling and genetic counseling outcomes in inpatient services. As demand for genetics expertise in inpatient care grows, genetic counselors can be hired to serve inpatient populations alongside genetics and non‐genetics providers.

U.S. Genetic counselors’ perceptions of inpatient genetic counseling: A valuable model for medically complex patients

“…In many cases, it allowed them to practice at the top of their scope, maximizing the use of their diverse and advanced board-certified skill set due to the fast-paced, stressful nature of the environment. Although specific information was not obtained about the independence of each participant's role in our study, our companion study by Magness et al (2021) found that 16.1% of inpatient GCs worked independently, without the supervision of a physician, a quality desirable to many GCs (Cohen and Tucker 2018;PSS, 2020) Participants in our study expressed that the spontaneity of consults, the variability of patient indications in the inpatient setting, and the challenge of preparing for consults quickly, kept the work exciting and feelings of burnout lower. In general, GCs have been shown to experience compassion fatigue and burnout (Bernhardt et al 2009;Cohen et al 2017;Cohen & Tucker, 2018) due to the emotionally taxing patient indications seen in genetics (Attard et al, 2019;Fennell et al 2020).…”

“…Participants were recruited from respondents to a quantitative survey study on inpatient genetic counseling by Magness et al (2021). This quantitative study recruited participants from the National Society of Genetic Counselors (NSGC) via the NSGC forum, which had over 4,000 NSGC members as subscribers at the time of survey distribution (NSGC Professional Status Survey (PSS), 2020).…”

“…Embedding a GC in inpatient care settings, where time is of the utmost importance, can add needed genetics expertise to a team that is already multidisciplinary in nature. While data is beginning to emerge on the use of inpatient genetic counseling (Ayres et al, 2019;Clowes Candadai et al, 2019;Deuitch et al, 2019;Magness et al 2021;Stark et al, 2018;Tan et al, 2019), it is unknown in a broad sense how this care is provided, in which genetic sub-specialties, or what the impact is on patients, the GCs themselves or other healthcare providers.…”

“…However, a recently published study has characterized the roles of GCs practicing in inpatient care settings as one that works collaboratively with various healthcare providers to provide genetics care in a variety of medical specialties (Magness et al 2021). Our study aimed to take the characterization a step further and describe genetic counselors' views of and experiences with providing genetic counseling services within inpatient care settings, including why their services were developed, how they are being executed in practice and the impact of their services as perceived by the inpatient GCs themselves.…”

Exploring collaboration models between geneticists and intensivists for implementing rapid genome sequencing in critical care settings

“…Although the number of GCs is increasing at a more rapid rate than geneticist colleagues, it is unknown if this rate is high enough to support the rising demand for these services in the critical care setting (Information on Genetic Counselor and Medical Geneticist Workforces, Report to Congressional Committees, 2020). Inpatient genetic counseling is an emerging area of practice, although not all GCs who provide this service have protected time to provide this care and many provide outpatient care while also being on call (Magness et al, 2021). The impact of this model on quality of patient care and burnout has not been explored, although one may suspect that providing protected time for GCs providing inpatient care would be helpful for both enhancing quality patient care and reducing burnout.…”