Next Generation Sequencing is the Impetus for the Next Generation of Laboratory‐Based Genetic Counselors

Abstract

Next generation sequencing (NGS) is dramatically increasing the number of clinically available genetic tests and thus the number of patients in which such testing may be indicated. The complex nature and volume of the reported results requires professional interpretation of the testing in order to translate and synthesize the meaning and potential benefit to patients, and genetic counselors are uniquely suited to provide this service. The increased need for genetic counselors in this role, coupled with the time required and a limited number of trained and available counselors presents a challenge to current models for making genetic testing available to patients and their healthcare providers effectively and efficiently. The employment of genetic counselors at genetic/genomic laboratories is one model to expand the resources for providing this service. In this article, we briefly review the advent of NGS and its clinical applications, examine the core skills of genetic counselors and delineate the expanding roles and responsibilities of laboratory-based genetic counselors. We also propose changes to the genetic counseling training program curriculum to account for the increasing opportunities for genetic counselors to contribute and thrive within genetic testing laboratories.

Too much, too soon?: Commercial provision of noninvasive prenatal screening for subchromosomal abnormalities and beyond

“…Prenatal genetic counseling is rarely considered a reimbursable expense under third-party payers, meaning that the number of practices that can afford to support prenatal counseling services will remain limited. While some testing companies offer telephone counseling services as part of their business model, it is far from clear that this will be sufficient to address the rising need and there are concerns about conflicts of interest (29,30). For the most part, physicians or other care providers who order these tests will have to counsel patients themselves (31).…”

Risk for Patient Harm in Canadian Genetic Counseling Practice: It's Time to Consider Regulation

“…It is not surprising then, that increasing numbers of genetic counselors have been hired to work in a variety of non-genetic clinical settings with non-geneticist physicians (Andermann and Narod 2002;Ingles et al 2011;Matloff and Barnett 2011;Mendes et al 2011;Powell et al 2010;Somers et al 2014;Swanson et al 2014;Vanstone et al 2012). A recent Canadian Association of Genetic Counseling professional status survey revealed that 15 % of respondents work with non-geneticist physicians or with no physicians (CAGC 2012a).…”

“…The pressure on primary care providers and non-genetics specialists to expand their role in genetic risk assessment and counseling is increasing, despite insufficient training and education (Andermann and Blancquaert 2010;Bensend et al 2014;Carroll et al 2009;Egalite et al 2014;Houwink et al 2012;Korf et al 2014;Mendes et al 2011;Shields et al 2008;Vanstone et al 2012;Zhou et al 2014). It is not surprising then, that increasing numbers of genetic counselors have been hired to work in a variety of non-genetic clinical settings with non-geneticist physicians (Andermann and Narod 2002;Ingles et al 2011;Matloff and Barnett 2011;Mendes et al 2011;Powell et al 2010;Somers et al 2014;Swanson et al 2014;Vanstone et al 2012). A recent Canadian Association of Genetic Counseling professional status survey revealed that 15 % of respondents work with non-geneticist physicians or with no physicians (CAGC 2012a).…”

“…A recent expansion of the definition of risk of harm to include mental harm further compels Ontario genetic counselors to investigate the need for regulation, given that a major component of the genetic counselor's role is to provide shortterm, client-centered counseling and psychological support and assist families with difficult, sometimes life-altering decisions (Austin et al 2014;Cameron and Muller 2009;Hooker et al 2014;Horowitz et al 2001;Martin et al 2010;Ormond 2013;Powell et al 2010;Resta 2006;Swanson et al 2014;Weil 2002).…”

Conflicts of interest in genetic counseling: acknowledging and accepting

“…At the profession-wide level, documentation of the employment status of genetic counselors through the annual status survey should include not only “work setting,” as it now does (http://www.nsgc.org/page/whoaregeneticcounselors), but also the source of employment—in order to reflect the increasing numbers of laboratory-employed genetic counselors who provide direct patient counseling outside of laboratories. This distinction has already been recognized by some insurers, which mandate (and reimburse) genetic counseling only by a non-laboratory-employed genetic counselor for certain covered genetic tests (11). Insurance coverage for genetic counseling may play an increasing role in the employment options of certified genetic counselors, as genetic information is increasingly integrated into clinical care.…”