Optimizing efficiency and skill utilization: Analysis of genetic counselors' attitudes regarding delegation in a clinical setting

Read, Parker; Yashar, Beverly M.; Robinson, Linda; Marvin, Monica

doi:10.1002/jgc4.1181

Cited by 6 publications

(7 citation statements)

References 34 publications

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“…As such, the use of standard/templated letters for the most common scenarios could drastically reduce the workload of re‐contact letter writing. In addition, management of incoming genetic test results and processing mail letters are activities genetic counselors find time‐consuming and are willing to delegate to supportive staff (Read et al, 2020). While possibly not the most effective, mail letters may be the most efficient way to implement a standard procedure of re‐contact.…”

Section: Discussionmentioning

confidence: 99%

Characterization of variant reclassification and patient re‐contact in a cancer genetics clinic

Muir

Reagle

2022

Journal of Genetic Counseling

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Expanded genetic testing guidelines for hereditary cancers, increased utilization of large multigene panels, and improved methods for reclassifying variants have led to a greater need to understand how variant reclassification and patient re‐contact are managed. This study aimed to describe the process of variant reclassification and subsequent patient re‐contact at a comprehensive cancer genetic counseling service in a large metropolitan medical center with several statewide satellite locations. A retrospective chart review was performed to identify reclassified variants between 1/1/1997 and 12/1/2020. In total, 8.4% (211/2503) of variants were reclassified over the 24‐year period, which includes multiple cases involving the same unique variant. Several variants underwent more than one reclassification, resulting in 232 total reclassifications among 194 individuals. Nearly all reclassifications were prompted by the laboratory (99.1%; 230/232) rather than the genetics clinic staff. Overall, 10.3% (24/232) of all reclassifications were upgrades, but only 9.1% (21/232) led to a change in management recommendations. The median time for variant reclassification was 1.7 years (interquartile range [IQR] = 0.8–3.2 years). There was no statistically significant difference in the time to reclassification for White patients (median = 1.6 years; IQR = 0.8–2.8 years) compared to non‐White patients (median = 2.0 years; IQR = 0.9–3.7 years; Mann–Whitney U = 4,764.0, p = 0.066). Patient re‐contact was attempted for 97.4% (226/232) of variants and was always performed by a genetic counselor, most often through a mailed letter (85.8%, 194/226). Specifically for reclassifications that led to a change in management recommendations, re‐contact was always attempted, most often through combined telephone and mailed letter (95.2%; 20/21). Overall, the median time from reclassification to attempted patient re‐contact was 13 days (range: 0–589 days). The characterization of this clinic's reclassification and re‐contact procedures can serve as an example for other genetics clinics trying to incorporate re‐contact into their workflow.

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Section: Discussionmentioning

confidence: 99%

Characterization of variant reclassification and patient re‐contact in a cancer genetics clinic

Muir

Reagle

2022

Journal of Genetic Counseling

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“…Within the inpatient care setting, this emotional burden has the potential to be even greater because many of the patients are seriously ill and the mortality rate can be higher. Burnout is an important component of practice to address as there is currently a shortage of GCs engaged in direct patient care (Attard et al, 2019;Cohen & Tucker, 2018;Hoskovec et al, 2018;McWalter et al, 2018;Read et al, 2020;Stoll et al, 2018). Many GCs have transitioned out of direct patient care, citing burnout, feeling undervalued, or seeking variable job responsibilities (Cohen et al 2017;Cohen & Tucker, 2018).…”

Section: Discussionmentioning

confidence: 99%

“…At a time in which genetic testing is becoming more accessible, less expensive, and has demonstrated clinical utility, the appropriate use of genetics expertise is vital so that patients with genetic disease receive proper clinical care (Read et al, 2020). As the use of genetic testing technologies in the inpatient care setting expands, genetic counselors (GCs) have the ability to play a critical role.…”

Section: Introductionmentioning

confidence: 99%

“…In the absence of GCs, some non-genetics healthcare providers with limited training in genetics provide genetic services (Bensend et al, 2014;Brierley et al, 2010Brierley et al, , 2012. In many cases, this results in misinformation, lack of psychosocial support, insufficient consent for genetic testing, and an absence of patient education (Attard et al, 2019;Bensend et al, 2014;Brierley et al, 2010;Read et al, 2020). Greater access to genetics expertise could rectify some of these adverse effects.…”

Section: Introductionmentioning

confidence: 99%

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

Clark

Reyes

Ormond

et al. 2021

Journal of Genetic Counseling

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Some genetic counselors (GCs) provide care in the inpatient setting. However, there is little literature on inpatient genetic counseling. The purpose of our study was to describe GC's experiences with the provision of genetic counseling services within inpatient care settings. Participants were recruited from respondents to a quantitative survey study on inpatient genetic counseling, which recruited GCs via the National Society of Genetic Counselors forum. GCs seeing at least five inpatients per year were invited to participate in semi-structured interviews. The interview guide explored how and why their inpatient genetic counseling service started, workflow, and the perceived impact of the service. Interviews were transcribed, inductive analysis was used to develop a codebook, and thematic analysis was used to identify themes.

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“…However, by utilizing standardized pre-test education that is appropriate for individuals with varying degrees of risk, and carefully curating a robust panel of genes with well-understood cancer risks and recommendations for clinical follow-up, more mutations would be detected, as seen in high-risk groups [70][71][72]. This would also allow GCs to operate at the top of their professional scope of practice by concentrating their expertise on counseling and results interpretation, especially for more complex cases [25,73]. As seen in the post-test survey, overall mean satisfaction with this model of education and testing was quite high, even among participants with VUSs (96.0/100).…”

Section: Education About Risk In the Communitymentioning

confidence: 99%

Evaluating the Effectiveness of a Telehealth Cancer Genetics Program: A BRCA Pilot Study

Rose

Hardy

Gates

et al. 2022

Public Health Genomics

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Introduction: Ashkenazi Jewish (AJ) individuals face a 1 in 40 (2.5%) risk of having a BRCA mutation, which is 10 times the general population risk. JScreen launched the PEACH BRCA Study, a telehealth-based platform for BRCA education and testing, with the goal of creating an effective model for BRCA testing in low-risk AJ individuals who do not meet national testing criteria. Other goals were to determine the rate of BRCA mutations in this group, to assess the adequacy of screening for the 3 common AJ founder mutations only, and to assess satisfaction with the telehealth model to help inform a national launch of a broader cancer genetic testing program. Methods: Criteria for participation included those who were AJ, resided in the metro-Atlanta area, were aged 25 and older, and had no personal or close family history of BRCA-related cancers. Pre-test education was provided through a video and written summary, followed by complimentary BRCA1/2 sequencing and post-test genetic counseling. Participants responded to pre- and post-test surveys, which assessed knowledge and satisfaction. Those who were not eligible to participate were sent genetic counseling resources and later surveyed. Results: Five hundred one participants were tested and the results included 4 positives (0.8% positivity rate), 494 negatives, and 3 variants of uncertain significance. Overall satisfaction with the study process was high (96.9/100), knowledge about BRCA was high (97.5% of participants passed a pre-test knowledge quiz), and satisfaction with pre- and post-test education was high (97.9% of participants were satisfied with the pre-test video and written summary, and 99.5% felt that their post-test genetic counseling session was valuable). Many participants expressed interest in receiving broader cancer testing. Conclusions: The BRCA founder mutation rate in a low-risk AJ population was significantly lower than the previously established AJ rate of 1 in 40. It was also determined that a telehealth model for a cancer genetics program is effective and acceptable to the population tested. This study established interest in broader cancer genetic testing through a telehealth platform and suggested that testing may be successful in the Jewish community at a national level and potentially in other populations, provided that patient education and genetic counseling are adequately incorporated.

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Optimizing efficiency and skill utilization: Analysis of genetic counselors' attitudes regarding delegation in a clinical setting

Cited by 6 publications

References 34 publications

Characterization of variant reclassification and patient re‐contact in a cancer genetics clinic

Characterization of variant reclassification and patient re‐contact in a cancer genetics clinic

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

Evaluating the Effectiveness of a Telehealth Cancer Genetics Program: A <b><i>BRCA</i></b> Pilot Study

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