Scheuner Maren T, Myrie Kenute, Peredo Jane, Hoffman-Hogg Lori, Lundquist Margaret, Guerra Stephanie L, Ball Douglas
is a Professor in Medicine and Pediatrics at the University of California, San Francisco School of Medicine and the Director of the Clinical Genetics Program, San Francisco US Department of Veteran Affairs (VA) Health Care System. is a Portfolio Manager for Oncology and Lead for Precision Oncology, Clinical Science Research and Development Service, VA Office of Research and Development is a Genetic Counselor at the Greater Los Angeles VA Healthcare System in California. is Program Manager for the Veterans Health Administration (VHA), National Center for Health Promotion and Disease Prevention in Durham, North Carolina, and National Oncology Clinical Advisor for the Office of Nurses Services in Washington, DC. is a Nurse Practitioner and is a Staff Physician with the Genomic Medicine Service, VHA Central Office. is an American Association for the Advancement of Science (AAAS) and Science and Technology Policy Fellow, VA Office of Research and Development.
Fed Pract. 2020 Aug;37(Suppl 4):S82-S88. doi: 10.12788/fp.0033.
The advent of germline testing as a standard-of-care practice for certain tumor types and patients presents unique opportunities and challenges for the field of precision oncology. This article describes strategies to address workforce capacity, organizational structure, and genetics education needs within the US Department of Veterans Affairs (VA) with the expectation that these approaches may be applicable to other health care systems.
Germline information can have health, reproductive, and psychosocial implications for veterans and their family members, which can pose challenges when delivering germline information in the setting of cancer care. Additional challenges include the complexity inherent in the interpretation of germline information, the national shortage of genetics professionals, limited awareness and knowledge about genetic principles among many clinicians, and organizational barriers, such as the inability to order genetic tests and receive results in the electronic health record. These challenges demand thoughtful implementation planning at the health care system level to develop sustainable strategies for the delivery of high-quality genetic services in precision oncology practice.
The VA is uniquely positioned to address the integration of germline genetic testing into precision oncology practice due to its outsized role in treating veterans with cancer, training the health care workforce, and developing, testing, and implementing innovative models of clinical care.
对于某些肿瘤类型和患者而言，将种系检测作为一种标准治疗方法的出现，为精准肿瘤学领域带来了独特的机遇和挑战。本文描述了美国退伍军人事务部（VA）应对劳动力能力、组织结构和遗传学教育需求的策略，期望这些方法也适用于其他医疗保健系统。
种系信息可能会对退伍军人及其家庭成员的健康、生殖和心理社会状况产生影响，这在癌症护理环境中提供种系信息时可能会带来挑战。其他挑战包括种系信息解读本身的复杂性、全国范围内遗传学专业人员短缺、许多临床医生对遗传原理的认识和了解有限，以及组织障碍，如无法在电子健康记录中订购基因检测并获取结果。这些挑战需要在医疗保健系统层面进行深思熟虑的实施规划，以制定在精准肿瘤学实践中提供高质量基因服务的可持续策略。
退伍军人事务部在治疗患癌退伍军人、培训医疗保健劳动力以及开发、测试和实施创新临床护理模式方面发挥着巨大作用，因此在将种系基因检测纳入精准肿瘤学实践方面具有独特优势。
