Assessment of clinical practices among cancer genetic counselors.

Various models of cancer genetics service delivery have been published, and practice guidelines were set forth by the National Society of Genetic Counselors (NSGC) in 2004. While the demand for services has increased, there has not been a comprehensive study of current practice models. An online survey of the NSGC Familial Cancer Risk Counseling Special Interest Group was conducted to study current methods of providing clinical cancer genetics services. Respondents were asked to quantify patient volume, support staff availability, and physician involvement in cases. Two case examples were used to further describe current practices including the number of genetic counseling tasks performed, time spent in these tasks, and number of in-person visits versus phone encounters. Although published cancer genetic counseling guidelines advise a 3-visit model (initial consult, sample draw, and result disclosure), 29.3% of respondents have adopted a 1-visit model, where the sample is drawn at the first visit and phone disclosure replaces the third visit. The content of the initial consult does not vary significantly, and is consistent with the NSGC practice guidelines. Furthermore, 56% report spending >15 min on case preparation, and 27 respondents self-reported redundancy in tasks such as documentation. It appears that a proportion of genetic counselors are following a new model of service delivery. However, insufficient documentation and case preparation are apparent, and many respondents reported lack of support staff as a barrier to efficient patient care. Factors contributing to the variability in current practice, and how they affect efficiency, require further study.