Factors influencing genetic counseling and testing for hereditary breast and ovarian cancer syndrome in a large US health care system

Medical genetic services are facing an unprecedented demand for counseling and testing for hereditary breast and ovarian cancer (HBOC) in a context of limited resources. To help resolve this issue, a collaborative oncogenetic model was recently developed and implemented at the CHU de Québec-Université Laval; Quebec; Canada. Here, we present the protocol of the C-MOnGene (Collaborative Model in OncoGenetics) study, funded to examine the context in which the model was implemented and document the lessons that can be learned to optimize the delivery of oncogenetic services. Within three years of implementation, the model allowed researchers to double the annual number of patients seen in genetic counseling. The average number of days between genetic counseling and disclosure of test results significantly decreased. Group counseling sessions improved participants’ understanding of breast cancer risk and increased knowledge of breast cancer and genetics and a large majority of them reported to be overwhelmingly satisfied with the process. These quality and performance indicators suggest this oncogenetic model offers a flexible, patient-centered and efficient genetic counseling and testing for HBOC. By identifying the critical facilitating factors and barriers, our study will provide an evidence base for organizations interested in transitioning to an oncogenetic model integrated into oncology care; including teams that are not specialized but are trained in genetics.

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Factors influencing coordination and continuity across care levels in the Catalan Health Care System

European Journal of Public Health ◽

10.1093/eurpub/ckv176.260 ◽

2015 ◽

Vol 25 (suppl_3) ◽

Author(s):

MB Aller ◽

S Waibel ◽

I Vargas ◽

ML Vázquez ◽

J Coderch ◽

...

Keyword(s):

Health Care ◽

Health Care System ◽

Factors Influencing ◽

Care System

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Health Care System and Policy Factors Influencing Engagement in HIV Medical Care: Piecing Together the Fragments of a Fractured Health Care Delivery System

Clinical Infectious Diseases ◽

10.1093/cid/ciq048 ◽

2011 ◽

Vol 52 (suppl_2) ◽

pp. S238-S246 ◽

Cited By ~ 155

Author(s):

Michael J. Mugavero ◽

Wynne E. Norton ◽

Michael S. Saag

Keyword(s):

Health Care ◽

Medical Care ◽

Health Care System ◽

Delivery System ◽

Health Care Delivery ◽

Care Delivery ◽

Health Care Delivery System ◽

Factors Influencing ◽

Care System

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Impact of race, socioeconomic status, and the health care system on the treatment of advanced-stage ovarian cancer in California

Gynecologic Oncology ◽

10.1016/j.ygyno.2014.03.412 ◽

2014 ◽

Vol 133 ◽

pp. 156-157

Author(s):

B.J. Long ◽

J. Chang ◽

A. Ziogas ◽

K.S. Tewari ◽

H. Anton-Culver ◽

...

Keyword(s):

Ovarian Cancer ◽

Health Care ◽

Socioeconomic Status ◽

Health Care System ◽

Advanced Stage ◽

Care System

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Factors Influencing Colorectal Cancer Screening Participation

Gastroenterology Research and Practice ◽

10.1155/2012/483417 ◽

2012 ◽

Vol 2012 ◽

pp. 1-8 ◽

Cited By ~ 63

Author(s):

Antonio Z. Gimeno García

Keyword(s):

Colorectal Cancer ◽

Health Care ◽

Health Care System ◽

Population Based ◽

Average Risk ◽

Major Health Problem ◽

Crc Screening ◽

Screening Uptake ◽

Factors Influencing ◽

Care System

Colorectal cancer (CRC) is a major health problem worldwide. Although population-based CRC screening is strongly recommended in average-risk population, compliance rates are still far from the desirable rates. High levels of screening uptake are necessary for the success of any screening program. Therefore, the investigation of factors influencing participation is crucial prior to design and launches a population-based organized screening campaign. Several studies have identified screening behaviour factors related to potential participants, providers, or health care system. These influencing factors can also be classified in non-modifiable (i.e., demographic factors, education, health insurance, or income) and modifiable factors (i.e., knowledge about CRC and screening, patient and provider attitudes or structural barriers for screening). Modifiable determinants are of great interest as they are plausible targets for interventions. Interventions at different levels (patient, providers or health care system) have been tested across the studies with different results. This paper analyzes factors related to CRC screening behaviour and potential interventions designed to improve screening uptake.

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Impact of race, socioeconomic status, and the health care system on the treatment of advanced-stage ovarian cancer in California

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2014.10.1104 ◽

2015 ◽

Vol 212 (4) ◽

pp. 468.e1-468.e9 ◽

Cited By ~ 41

Author(s):

Beverly Long ◽

Jenny Chang ◽

Argyrios Ziogas ◽

Krishnansu S. Tewari ◽

Hoda Anton-Culver ◽

...

Keyword(s):

Ovarian Cancer ◽

Health Care ◽

Socioeconomic Status ◽

Health Care System ◽

Advanced Stage ◽

Care System

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What are factors influencing coordination and continuity across care levels in the Catalan national health care system?

International Journal of Integrated Care ◽

10.5334/ijic.2716 ◽

2016 ◽

Vol 16 (6) ◽

pp. 168

Author(s):

Marta B Aller ◽

Sina Waibel ◽

Ingrid Vargas ◽

M Luisa Vázquez ◽

Jordi Coderch ◽

...

Keyword(s):

Health Care ◽

Health Care System ◽

National Health ◽

National Health Care ◽

National Health Care System ◽

Factors Influencing ◽

Care System

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A Comprehensive Program Enabling Effective Delivery of Regional Genetic Counseling

International Journal of Gynecological Cancer ◽

10.1097/igc.0000000000001256 ◽

2018 ◽

Vol 28 (5) ◽

pp. 996-1002 ◽

Cited By ~ 4

Author(s):

Jubilee Brown ◽

Aly Athens ◽

David L. Tait ◽

Erin K. Crane ◽

Robert V. Higgins ◽

...

Keyword(s):

Breast Cancer ◽

Ovarian Cancer ◽

Health Care ◽

Genetic Counseling ◽

Cancer Patients ◽

Health Care System ◽

Patient Navigation ◽

Counseling Services ◽

Comprehensive Program ◽

Genetic Counseling Services

ObjectivesThe aim of this study was to demonstrate the utility of a comprehensive program involving management-based evidence, telemedicine, and patient navigation to provide genetic counseling services for patients with ovarian and breast cancer across a geographically large health care system.MethodsWe identified all patients with newly diagnosed ovarian and breast cancer in our health care system from January 2013 to December 2015 through the cancer registry. Referral characteristics and testing outcomes were recorded for each year and compared using the χ2 or Fisher exact test.ResultsBecause the implementation of this program, the number of new ovarian cancer cases remained constant (109–112 cases/year) but patients referred for genetic counseling increased annually from 37% to 43% to 96% (P < 0.05). The percentage of ovarian cancer patients who underwent genetic testing increased annually from 24% to 27% to 53% (P < 0.05). The number of new breast cancer patients was constant (1543–1638 cases/year). The percentage of patients with triple negative breast cancer referred for genetic counseling rose from 69% in 2013 to 91% in 2015; the percentage of patients who underwent testing increased annually from 59% to 86% (P < 0.05). Of women with breast cancer diagnosed at less than 45 years of age, 78% to 85% were referred for genetic counseling across this period; the percentage of patients who underwent testing increased annually from 66% to 82% (P < 0.05). Patient navigation was initiated and was available to all patients in the system during this period. Telemedicine consults were performed in 118 breast/ovarian patients (6%) during this period.ConclusionsA comprehensive program may improve access to effective genetic counseling services in patients with ovarian and breast cancer despite geographic barriers.

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