Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre, Singapore City, Singapore.
Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore City, Singapore.
J Genet Couns. 2020 Dec;29(6):1192-1199. doi: 10.1002/jgc4.1286. Epub 2020 May 5.
Family history taking is a fundamental part of genetic counseling, and however, it is also a time-consuming process. To cope with the increasing demands at the Cancer Genetics Service in Singapore, alternative methods to collect patients' family history were implemented to reduce the duration of the initial consultation and increase the clinic's capacity. Two interventions were performed in this study, where a family history questionnaire and telephone intakes (telephone calls to collect patient family history) were implemented prior to a cancer genetics consultation. The primary outcome of this study is the duration of the initial consultation in relation to both interventions while the secondary outcome is the clinic attendance rate before and after implementing the telephone intake. The impact of interventions was evaluated with a Plan-Do-Study-Act (PDSA) methodology. The use of a family history questionnaire could not be evaluated due to poor patient response while the telephone intake was found to be feasible among the local population. Two improvements were observed after the implementation of telephone intake: (a) a significant reduction in the duration of the initial consultation from 60 to 45 min (p = .001) and (b) a significant increase of 29.7% in clinic attendance (p = .01). This study demonstrates that collecting family history information ahead of genetic counseling via telephone intake is a useful measure in improving clinic capacity, which potentially resulting in optimization of clinical resources.
家族史采集是遗传咨询的基本组成部分,但也是一个耗时的过程。为了应对新加坡癌症遗传学服务中心日益增长的需求,我们实施了替代方法来收集患者的家族史,以缩短初始咨询的时间并增加诊所的容量。本研究实施了两项干预措施,即在癌症遗传学咨询之前使用家族史问卷和电话咨询(打电话收集患者家族史)。本研究的主要结果是与这两项干预措施相关的初始咨询的持续时间,次要结果是实施电话咨询前后的诊所就诊率。使用计划-执行-研究-行动 (PDSA) 方法评估干预措施的影响。由于患者反应不佳,无法评估家族史问卷的使用情况,而电话咨询在当地人群中被发现是可行的。实施电话咨询后观察到了两项改进:(a) 初始咨询的持续时间从 60 分钟显著减少到 45 分钟(p=0.001),(b) 就诊率显著增加 29.7%(p=0.01)。这项研究表明,通过电话咨询在遗传咨询之前收集家族史信息是一种有用的措施,可以提高诊所的容量,从而优化临床资源的利用。