Creation and Implementation of an Environmental Scan to Assess Cancer Genetics Services at Three Oncology Care Settings

  • Erica M. Bednar
  • Michael T. WalshJr.
  • Ellen Baker
  • Kimberly I. Muse
  • Holly D. Oakley
  • Rebekah C. Krukenberg
  • Cara S. Dresbold
  • Sandra B. Jenkinson
  • Amanda L. Eppolito
  • Kelly B. Teed
  • Molly H. Klein
  • Nichole A. Morman
  • Elizabeth C. Bowdish
  • Pauline Russ
  • Emaline E. Wise
  • Julia N. Cooper
  • Michael W. Method
  • John W. Henson
  • Andrew V. Grainger
  • Banu K. Arun
  • Karen H. Lu
Original Research

Abstract

An environmental scan (ES) is an efficient mixed-methods approach to collect and interpret relevant data for strategic planning and project design. To date, the ES has not been used nor evaluated in the clinical cancer genetics setting. We created and implemented an ES to inform the design of a quality improvement (QI) project to increase the rates of adherence to national guidelines for cancer genetic counseling and genetic testing at three unique oncology care settings (OCS). The ES collected qualitative and quantitative data from reviews of internal processes, past QI efforts, the literature, and each OCS. The ES used a data collection form and semi-structured interviews to aid in data collection. The ES was completed within 6 months, and sufficient data were captured to identify opportunities and threats to the QI project’s success, as well as potential barriers to, and facilitators of guideline-based cancer genetics services at each OCS. Previously unreported barriers were identified, including inefficient genetic counseling appointment scheduling processes and the inability to track referrals, genetics appointments, and genetic test results within electronic medical record systems. The ES was a valuable process for QI project planning at three OCS and may be used to evaluate genetics services in other settings.

Keywords

Quality improvement Environmental scan Hereditary cancer Cancer genetics Genetic counseling Genetic testing Health systems 

Notes

Acknowledgements

We would like to thank Pamela Dickerson, Rhonda Broome, and Gail Frankeberger for their assistance with MD Anderson Cancer Network-related questions, Dr. Laura Bashoura of the MD Anderson Cancer Center Quality Improvement Assessment Board for her guidance on the QI project, the Department of Scientific Publications, the leadership of the MD Anderson Cancer Network and MD Anderson Physician Network, and the leadership of the MD Anderson Cancer Moon Shots Program for their support.

Authorship Contributions

  • Concept or design of the study: Erica M. Bednar, Michael T. Walsh Jr., Ellen Baker, Kimberly I. Muse, Holly D. Oakley, Banu K. Arun, Karen H. Lu

  • Acquisition, analysis, or interpretation of data for the study: Erica M. Bednar, Kimberly I. Muse, Holly D. Oakley, Rebekah C. Krukenberg, Cara S. Dresbold, Sandra B. Jenkinson, Amanda L. Eppolito, Kelly B. Teed, Molly H. Klein, Nichole A. Morman, Elizabeth C. Bowdish, Pauline Russ, Emaline E. Wise, Julia N. Cooper, Michael W. Method, John W. Henson, Andrew V. Grainger

  • Drafted or critically revised the article for important intellectual content: Erica M. Bednar, Michael T. Walsh Jr., Ellen Baker, Kimberly I. Muse, Holly D. Oakley, Rebekah C. Krukenberg, Cara S. Dresbold, Sandra B. Jenkinson, Amanda L. Eppolito, Kelly B. Teed, Molly H. Klein, Nichole A. Morman, Elizabeth C. Bowdish, Pauline Russ, Emaline E. Wise, Julia N. Cooper, Michael W. Method, John W. Henson, Andrew V. Grainger, Banu K. Arun, Karen H. Lu

  • Final approval of the version of the article to be published: Erica M. Bednar, Michael T. Walsh Jr., Ellen Baker, Kimberly I. Muse, Holly D. Oakley, Rebekah C. Krukenberg, Cara S. Dresbold, Sandra B. Jenkinson, Amanda L. Eppolito, Kelly B. Teed, Molly H. Klein, Nichole A. Morman, Elizabeth C. Bowdish, Pauline Russ, Emaline E. Wise, Julia N. Cooper, Michael W. Method, John W. Henson, Andrew V. Grainger, Banu K. Arun, Karen H. Lu

  • Agree to be accountable for all aspects of the article in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: Erica M. Bednar, Michael T. Walsh Jr., Ellen Baker, Kimberly I. Muse, Holly D. Oakley, Rebekah C. Krukenberg, Cara S. Dresbold, Sandra B. Jenkinson, Amanda L. Eppolito, Kelly B. Teed, Molly H. Klein, Nichole A. Morman, Elizabeth C. Bowdish, Pauline Russ, Emaline E. Wise, Julia N. Cooper, Michael W. Method, John W. Henson, Andrew V. Grainger, Banu K. Arun, Karen H. Lu

Funding

This project was funded by the MD Anderson Breast Cancer and Ovarian Cancer Moon Shots™ Programs and Phillips 66. This work was also supported by the NIH/NCI under award number P30CA016672.

Compliance with Ethical Standards

Conflict of Interest

Authors Bednar, Walsh, Baker, Muse, Oakley, Krukenberg, Dresbold, Jenkinson, Eppolito, Teed, Klein, Morman, Bowdish, Russ, Wise, Cooper, Method, Henson, Grainger, Arun, and Lu (all authors) declare that they have no conflict of interest.

Human Studies and Informed Consent

For this study, formal consent was not required. No studies of human subjects were carried out by the authors for this article. No patient identifying information was obtained for this study. Informed consent was not required for this study. The work described in this article was the planning component of a quality improvement project, approved by the University of Texas MD Anderson Cancer Center Quality Improvement Assessment Board. The quality improvement project was subsequently reviewed by each collaborating site’s institutional review board and approved as a clinical, non-research project, subject to ongoing review.

Animal Studies

No animal studies were carried out by the authors for this article.

Supplementary material

10897_2018_262_MOESM1_ESM.docx (17 kb)
ESM 1 (DOCX 16 kb)

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Copyright information

© National Society of Genetic Counselors, Inc. 2018

Authors and Affiliations

  • Erica M. Bednar
    • 1
    • 2
  • Michael T. WalshJr.
    • 2
  • Ellen Baker
    • 2
  • Kimberly I. Muse
    • 1
  • Holly D. Oakley
    • 1
  • Rebekah C. Krukenberg
    • 3
  • Cara S. Dresbold
    • 3
  • Sandra B. Jenkinson
    • 3
  • Amanda L. Eppolito
    • 4
  • Kelly B. Teed
    • 4
  • Molly H. Klein
    • 4
  • Nichole A. Morman
    • 5
  • Elizabeth C. Bowdish
    • 5
  • Pauline Russ
    • 5
  • Emaline E. Wise
    • 5
  • Julia N. Cooper
    • 5
  • Michael W. Method
    • 6
  • John W. Henson
    • 4
  • Andrew V. Grainger
    • 7
  • Banu K. Arun
    • 8
  • Karen H. Lu
    • 9
  1. 1.The Department of Clinical Cancer GeneticsThe University of Texas MD Anderson Cancer CenterHoustonUSA
  2. 2.The Cancer Prevention and Control Platform, Moon Shots Program™The University of Texas MD Anderson Cancer CenterHoustonUSA
  3. 3.Oncology Genetic Counseling, Community Health NetworkIndianapolisUSA
  4. 4.Piedmont Cancer, Piedmont HealthcareAtlantaUSA
  5. 5.Genetic Counseling Program, OhioHealthColumbusUSA
  6. 6.Gynecologic Cancer Care, Community Health NetworkIndianapolisUSA
  7. 7.Department of Cancer Services, OhioHealthColumbusUSA
  8. 8.Department of Breast Medical OncologyThe University of Texas MD Anderson Cancer CenterHoustonUSA
  9. 9.Department of Gynecologic Oncology and Reproductive MedicineThe University of Texas MD Anderson Cancer CenterHoustonUSA

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