将遗传咨询师嵌入肿瘤诊所可提高卵巢癌女性的检测率和及时性。
Embedding a genetic counselor into oncology clinics improves testing rates and timeliness for women with ovarian cancer.
机构信息
Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA; Division of Cancer Genetics and Prevention, Dana-Farber Cancer Institute, Boston, MA, USA.
Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Division of Cancer Genetics and Prevention, Dana-Farber Cancer Institute, Boston, MA, USA.
出版信息
Gynecol Oncol. 2021 Feb;160(2):457-463. doi: 10.1016/j.ygyno.2020.11.003. Epub 2020 Nov 21.
OBJECTIVE
Germline genetic testing is crucial to the care of ovarian cancer patients, and as part of the guideline-based care for ovarian cancer patient's adherence to this recommendation has been low. We sought to determine whether embedding a genetic counselor (GC) within a medical and gynecologic oncology clinic would increase testing rates and improve the timeliness of testing.
METHODS
Prospective cohort study of 358 ovarian cancer patients seen by medical and gynecologic oncologists between 2013 and 2015. Rates of referrals, completion of counseling, and genetic testing and timeliness of counseling were abstracted before and after a GC was embedded in the clinic in 2014. An additional year of data (2015) was collected to evaluate sustainability of the intervention.
RESULTS
Between 2013 and 2015, 88-92% of women were referred for genetic testing, but in 2013 only 66% completed counseling and 61% were tested. After a GC was embedded in the clinic in 2014, more than 80% of referred women completed counseling and germline genetic testing. Time to genetic counseling also decreased from a median of 107 to 40 days, irrespective of age and cancer family history (p < 0.01).
CONCLUSIONS
Embedding a GC into the workflow for ovarian cancer patients is an effective way of improving access to genetic counseling, testing rates, and the timeliness of testing.
目的
胚系基因检测对于卵巢癌患者的治疗至关重要，作为基于指南的卵巢癌患者护理的一部分，患者对这一建议的依从性一直较低。我们旨在确定在医疗和妇科肿瘤学诊所中嵌入遗传咨询师（GC）是否会提高检测率并改善检测的及时性。
方法
这是一项前瞻性队列研究，纳入了 2013 年至 2015 年间由医疗和妇科肿瘤学家诊治的 358 名卵巢癌患者。在 2014 年 GC 嵌入诊所之前和之后，分别对转诊、咨询完成情况、基因检测以及咨询的及时性进行了回顾性分析。收集了额外一年（2015 年）的数据，以评估干预措施的可持续性。
结果
2013 年至 2015 年，88%-92%的女性被转介进行基因检测，但在 2013 年，只有 66%的女性完成了咨询，61%的女性进行了检测。2014 年 GC 嵌入诊所后，超过 80%的转介女性完成了咨询和胚系基因检测。遗传咨询的时间也从中位数 107 天缩短至 40 天，无论年龄和癌症家族史如何（p<0.01）。
结论
将 GC 嵌入卵巢癌患者的工作流程是一种提高基因咨询、检测率和检测及时性的有效方法。
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