Models of Service Delivery for Cancer Genetic Risk Assessment and Counseling

Abstract

Increasing awareness of and the potentially concomitant increasing demand for cancer genetic services is driving the need to explore more efficient models of service delivery. The aims of this study were to determine which service delivery models are most commonly used by genetic counselors, assess how often they are used, compare the efficiency of each model as well as impact on access to services, and investigate the perceived benefits and barriers of each. Full members of the NSGC Familial Cancer Special Interest Group who subscribe to its listserv were invited to participate in a web-based survey. Eligible respondents were asked which of ten defined service delivery models they use and specific questions related to aspects of model use. One-hundred ninety-two of the approximately 450 members of the listserv responded (42.7%); 177 (92.2%) had provided clinical service in the last year and were eligible to complete all sections of the survey. The four direct care models most commonly used were the (traditional) face-to-face pre- and post-test model (92.2%), the face-to-face pretest without face-to-face post-test model (86.5%), the post-test counseling only for complex results model (36.2%), and the post test counseling for all results model (18.3%). Those using the face-to-face pretest only, post-test all, and post-test complex models reported seeing more new patients than when they used the traditional model and these differences were statistically significantly. There were no significant differences in appointment wait times or distances traveled by patients when comparing use of the traditional model to the other three models. Respondents recognize that a benefit of using alternative service delivery models is increased access to services; however, some are concerned that this may affect quality of care.

A prospective cohort study assessing clinical referral management & workforce allocation within a UK regional medical genetics service

“…36,37 In the United States a recent survey shows wide variation in genetic counsellor service delivery models, unfortunately in part this variation is explained by limits imposed by billing and bureaucracy, not always by good practice. 38 The methodological techniques of implementation science, 39 including the conduct of implementation trials and the study of complex interventions could be beneficial in building the evidence base on which to develop new ways of working to optimise skill mix and workforce utilisation in genetic service delivery models. 40 Further research needs to be undertaken to establish how best to integrate patient reported outcome and satisfaction measures within routine genetic health service delivery.…”

Patient feedback and early outcome data with a novel tiered-binned model for multiplex breast cancer susceptibility testing

“…3,[7][8][9][10] The advantages and disadvantages of testing options must be shared with patients so they can make an informed decision regarding genetic testing. 8,[11][12][13][14] Traditional comprehensive models for pretest counseling and informed consent could be associated with information overload and poor informed decision making. 7,15 In addition, multiplex testing has the potential to increase anxiety, uncertainty, and the adoption of inappropriate screening procedures or risk-reducing surgeries.…”

Interventions to improve patient access to and utilisation of genetic and genomic counselling services.

“…These services are available in most countries and patients have a right to access them. However, there is great variation in how they are organised, delivered and funded (WHO 2010; Trepanier 2014). Increasingly, genetic and genomic counselling services are situated within other clinical specialties, such as a breast cancer family history clinic operating as part of an oncology service (Burton 2011; Kirk 2014).…”