Increasing genetic counseling referral rates through bundled interventions after ovarian cancer diagnosis

To increase genetic counseling referrals for patients with newly diagnosed epithelial ovarian cancer (EOC). A practice-gap analysis was performed after measuring baseline genetic counseling referral rates to identify barriers to referral from the multidisciplinary single institution EOC care group....

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Bibliographic Details
Published in:	Gynecologic oncology Vol. 149; no. 1; pp. 121 - 126
Main Authors:	Swanson, Casey L., Kumar, Amanika, Maharaj, Joy M., Kemppainen, Jennifer L., Thomas, Brittany C., Weinhold, Megan R., Slaby, Kristine M., Mara, Kristin C., Wick, Myra J., Bakkum-Gamez, Jamie N.
Format:	Journal Article
Language:	English
Published:	United States Elsevier Inc 01-04-2018
Subjects:	Carcinoma, Ovarian Epithelial Cohort Studies Female Genetic counseling Genetic Counseling - methods Genetic Counseling - statistics & numerical data Genetic testing Humans Middle Aged Neoplasms, Glandular and Epithelial - diagnosis Neoplasms, Glandular and Epithelial - genetics Ovarian cancer Ovarian Neoplasms - diagnosis Ovarian Neoplasms - genetics Practice Patterns, Physicians Referral Referral and Consultation - statistics & numerical data Genetic counseling Genetic testing Referral Ovarian cancer
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Summary:	To increase genetic counseling referrals for patients with newly diagnosed epithelial ovarian cancer (EOC). A practice-gap analysis was performed after measuring baseline genetic counseling referral rates to identify barriers to referral from the multidisciplinary single institution EOC care group. A Genetics Referral Toolkit consisting of a referral template, a genetic risk checklist, family history worksheet and provider and patient awareness was developed to address identified gaps with the goal of increasing referral rates. Clinical characteristics, referral placement, completion of genetic counseling/testing were abstracted for a historic cohort and intervention cohort. Data for the two cohorts were compared using chi-square, Fisher's exact test, or t-test. Association with referral was determined by univariate logistic regression. Eighty one patients from July through December 2013 (historic cohort) and 62 patients from July through December 2015 (intervention cohort) were identified as having a new diagnosis of EOC. Among these women, genetic counseling referral rates increased from 48.1% (39/81) in 2013 to 74.2% (46/62) in 2015 (p=0.002) after implementation of the toolkit. In a subset of patients without a previous genetic counseling referral, 87.9% (29/33) completed counseling and 79.3% (23/29) pursued testing from the historic cohort. In the intervention cohort, 60% (24/40) were seen for counseling and 100% (24/24) had testing. Application of a quality improvement process to create a Genetics Referral Toolkit increased the genetic counseling referral rate in patients with a new diagnosis of EOC. The majority of patients who were referred completed genetics consultation and elected genetic testing. •Implementation of bundled interventions improved genetics referral in EOC patients.•Genetics referrals from oncology providers yield a high rate of consult completion.•There is a high rate of completing genetic testing after genetic counseling.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0090-8258 1095-6859
DOI:	10.1016/j.ygyno.2018.01.033