Trepanier Angela M, Allain Dawn C
Center for Molecular Medicine and Genetics, Wayne State University, 540 E. Canfield Street, 2375 Scott Hall, Detroit, MI, 48201, USA,
J Genet Couns. 2014 Apr;23(2):239-53. doi: 10.1007/s10897-013-9655-6. Epub 2013 Oct 26.
Increasing awareness of and the potentially concomitant increasing demand for cancer genetic services is driving the need to explore more efficient models of service delivery. The aims of this study were to determine which service delivery models are most commonly used by genetic counselors, assess how often they are used, compare the efficiency of each model as well as impact on access to services, and investigate the perceived benefits and barriers of each. Full members of the NSGC Familial Cancer Special Interest Group who subscribe to its listserv were invited to participate in a web-based survey. Eligible respondents were asked which of ten defined service delivery models they use and specific questions related to aspects of model use. One-hundred ninety-two of the approximately 450 members of the listserv responded (42.7%); 177 (92.2%) had provided clinical service in the last year and were eligible to complete all sections of the survey. The four direct care models most commonly used were the (traditional) face-to-face pre- and post-test model (92.2%), the face-to-face pretest without face-to-face post-test model (86.5%), the post-test counseling only for complex results model (36.2%), and the post test counseling for all results model (18.3%). Those using the face-to-face pretest only, post-test all, and post-test complex models reported seeing more new patients than when they used the traditional model and these differences were statistically significantly. There were no significant differences in appointment wait times or distances traveled by patients when comparing use of the traditional model to the other three models. Respondents recognize that a benefit of using alternative service delivery models is increased access to services; however, some are concerned that this may affect quality of care.
对癌症基因服务的认识不断提高以及随之而来的潜在需求不断增加，促使人们需要探索更高效的服务提供模式。本研究的目的是确定基因咨询师最常用的服务提供模式，评估其使用频率，比较每种模式的效率以及对服务可及性的影响，并调查每种模式的感知益处和障碍。邀请了订阅NSGC家族性癌症特别兴趣小组邮件列表的正式成员参加一项基于网络的调查。符合条件的受访者被问及他们使用的十种定义的服务提供模式中的哪一种，以及与模式使用方面相关的具体问题。邮件列表中约450名成员中的192人回复（42.7%）；177人（92.2%）在过去一年中提供过临床服务，有资格完成调查的所有部分。最常用的四种直接护理模式是（传统的）面对面测试前和测试后模式（92.2%）、面对面测试前但无面对面测试后模式（86.5%）、仅针对复杂结果的测试后咨询模式（36.2%）以及针对所有结果的测试后咨询模式（18.3%）。那些仅使用面对面测试前、所有结果测试后和复杂结果测试后模式的人报告说，与使用传统模式相比，他们接待的新患者更多，这些差异具有统计学意义。将传统模式与其他三种模式进行比较时，患者的预约等待时间或出行距离没有显著差异。受访者认识到使用替代服务提供模式的一个好处是增加了服务可及性；然而，一些人担心这可能会影响护理质量。
