Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI, United States.
Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI, United States.
Gynecol Oncol. 2018 Jun;149(3):565-569. doi: 10.1016/j.ygyno.2018.03.059. Epub 2018 Apr 10.
The National Comprehensive Cancer Network recommends all women with ovarian cancer be offered genetic testing. Despite a decade of endorsement, many oncology practitioners have yet to make this a part of routine practice. Referral to genetic counseling and completion of genetic testing among patients at substantial risk of germline mutations are significantly lacking, adversely affecting patient care and squandering an opportunity to maximize cancer prevention efforts. This project determined the impact and feasibility of implementing a basic model for universal referral to genetic counseling and completion of genetic testing in women with a diagnosis of ovarian cancer in an academic gynecology oncology practice with access to electronic health records (EHRs).
Patients diagnosed with ovarian cancer from January 2008 to November 2013 were retrospectively reviewed to determine the baseline referral rate for genetic counseling and testing completion in our practice. Implementation of a process change model combining provider training, patient education, enhanced electronic health record documentation and improved patient appointment scheduling strategies were implemented. We then prospectively collected data on all newly diagnosed ovarian cancer patients that had not already undergone genetic testing presenting from December 1, 2013 to November 30, 2016.
Genetic referral rates, genetic counseling and testing completion rates were markedly improved. Pre-implementation our genetic testing rate was 27% and post implementation our testing rate was 82% (p-value≤0.001).
Low cost interventions that target education of both providers and patients regarding the importance of genetic testing along with utilization of the EHR and streamlined patient appointment services can significantly increase rates of genetic testing completion.
美国国家综合癌症网络建议所有卵巢癌患者都接受基因检测。尽管这一建议已经提出了十年，但许多肿瘤医生仍未将其纳入常规实践。对于存在种系突变高风险的患者，向遗传咨询师转诊和完成基因检测的比例明显不足，这对患者的护理产生了不利影响，也浪费了最大限度地开展癌症预防工作的机会。本项目旨在确定在一家能够获取电子病历（EHR）的学术妇科肿瘤学实践中，实施一种普遍向遗传咨询师转诊和完成基因检测的基本模式，对患者的影响和可行性。
回顾性分析 2008 年 1 月至 2013 年 11 月期间被诊断为卵巢癌的患者，以确定我们实践中遗传咨询和检测完成的基线转诊率。实施了一种结合提供者培训、患者教育、增强电子病历记录和改善患者预约安排策略的流程改变模型。然后，我们前瞻性地收集了自 2013 年 12 月 1 日至 2016 年 11 月 30 日期间新诊断为卵巢癌且尚未进行基因检测的所有患者的数据。
遗传咨询转诊率和基因检测完成率显著提高。在实施前，我们的基因检测率为 27%，实施后为 82%（p 值≤0.001）。
针对提供者和患者进行基因检测重要性教育的低成本干预措施，结合电子病历的利用和简化患者预约服务，可以显著提高基因检测完成率。
