This study aimed to evaluate a unique approach to cancer risk assessment for improved access by smaller rural communities.
Local, on-site nurse navigators were trained and utilized as genetic counselor extenders (GCEs) to provide basic risk assessment and offer BRCA1/2 genetic testing to select patients based on a triaging process in collaboration with board-certified genetic counselors (CGCs).
From August 2012 to July 2014, 12,477 family history questionnaires representing 8937 unique patients presenting for a screening mammogram or new oncology appointment were triaged. Of these, 8.2 % patients were identified at increased risk for hereditary breast cancer, and 4.2 % were identified at increased risk for other hereditary causes of cancer. A total of 75 of 1130 at-risk patients identified (6.6 %) completed a genetic risk assessment appointment; 23 with a GCE and 52 with a CGC. A review of the completed genetic test requisition forms from a 9-year pre-collaboration time period found that 16 % (20/125) did not appear to meet genetic testing criteria. Overall, there was a fourfold increase in patients accessing genetic services in this study period compared to the pre-collaboration time period. Efficiency of this model was assessed by determining time spent by the CGC in all activities related to the collaboration, which amounted to approximately 16 h/month. Adjustments have been made and the program continues to be monitored for opportunities to improve efficiency.
This study demonstrates the feasibility of CGCs and GCEs collaborating to improve access to quality services in an efficient manner.
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The authors thank Kathryn Murray, MS, CGC for allowing them to use the term “Genetic Counselor Extender,” which she coined. The authors would also like to acknowledge their current GCEs, Michelle Meyer, RN and Lisa Ruehr, RN, who have made this project possible as well as Heather Elston, BS, who assisted with data management.
All procedures followed here were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 (5). Written informed consent was not required by St. Vincent Institutional Review Board (2014-053), because no identifying information was collected.
Conflict of interest
The authors declare that they have no conflict of interest.
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Cohen, S.A., Nixon, D.M. A collaborative approach to cancer risk assessment services using genetic counselor extenders in a multi-system community hospital. Breast Cancer Res Treat 159, 527–534 (2016). https://doi.org/10.1007/s10549-016-3964-z
- Genetic counseling
- Hereditary cancer risk assessment
- Genetic counselor extenders