泌尿外科医生、肿瘤学家和执业护士在转移性前列腺癌主流基因检测方面的经验。
Experience of urologists, oncologists and nurse practitioners with mainstream genetic testing in metastatic prostate cancer.
作者信息
Vlaming Michiel, Ausems Margreet G E M, Kiemeney Lambertus A L M, Schijven Gina, van Melick Harm H E, Noordzij M Arjen, Somford Diederik M, van der Poel Henk G, Wijburg Carl J, Wijsman Bart P, Hoekstra Robert J, van Moorselaar Reindert J A, van Bezooijen Bart P J, Meijer Richard P, Busstra Martijn B, van den Berg H Pieter, Robbrecht Debbie G J, Doornweerd Benjamin H J, Bleiker Eveline M A, van Oort Inge M
机构信息
Department of Genetics, Division Laboratories, Pharmacy and Biomedical Genetics, University Medical Center Utrecht, Utrecht, The Netherlands.
Department for Health Evidence, Radboud university medical center, Nijmegen, The Netherlands.
出版信息
Prostate Cancer Prostatic Dis. 2024 Dec 5. doi: 10.1038/s41391-024-00925-w.
BACKGROUND
International guidelines recommend germline genetic testing for men with metastatic prostate cancer. If offered to all patients by genetic healthcare professionals, there will be insufficient capacity to cope with the high patient numbers. In a mainstreaming pathway, non-genetic healthcare professionals (ngHCPs) discuss and order germline genetic testing instead of referring patients to genetic healthcare professionals. We aimed to evaluate the experience of ngHCPs with pre-test genetic counselling and to explore the feasibility from the ngHCPs' perspective.
METHODS
We carried out a prospective cohort study in 15 hospitals in the Netherlands. All participating ngHCPs (i.e. urologists, medical oncologists, specialist nurses and nurse practitioners) completed an online training module of 45 min. The ngHCPs completed a questionnaire both before the training and at three and nine months after it. Paired analyses were used to compare the first with the last questionnaires on attitude, confidence in the ability to discuss and order germline genetic testing, and perceived and actual knowledge of genetics and genetic testing.
RESULTS
167 ngHCPs were invited to participate of whom 69 completed the first questionnaire and started or completed the last one. They had a positive attitude towards offering genetic testing themselves. After nine months of providing pre-test genetic counselling, significantly more ngHCPs considered mainstreaming helpful (94% after versus 81% before, p = 0.01). Both perceived and actual knowledge increased significantly. Pre-test genetic counselling took less than 10 minutes for 82% of ngHCPs and the majority (88%) were in favour of continuing the mainstream pathway. Only six participating ngHCPs considered mainstreaming possible without completing a training module beforehand.
CONCLUSIONS
After completing a short online training module, ngHCPs feel well-prepared to discuss germline genetic testing with metastatic prostate cancer patients.
背景
国际指南建议对转移性前列腺癌男性患者进行胚系基因检测。如果由基因医疗保健专业人员向所有患者提供检测，将没有足够的能力应对大量患者。在一种主流化途径中，非基因医疗保健专业人员（ngHCPs）讨论并安排胚系基因检测，而不是将患者转介给基因医疗保健专业人员。我们旨在评估ngHCPs进行检测前遗传咨询的经验，并从ngHCPs的角度探讨其可行性。
方法
我们在荷兰的15家医院开展了一项前瞻性队列研究。所有参与的ngHCPs（即泌尿科医生、医学肿瘤学家、专科护士和执业护士）完成了一个45分钟的在线培训模块。ngHCPs在培训前以及培训后3个月和9个月完成了一份问卷。采用配对分析比较第一份问卷和最后一份问卷在态度、讨论和安排胚系基因检测能力的信心以及对遗传学和基因检测的感知知识与实际知识方面的差异。
结果
邀请了167名ngHCPs参与，其中69名完成了第一份问卷并开始或完成了最后一份问卷。他们对自己提供基因检测持积极态度。在提供检测前遗传咨询9个月后，显著更多的ngHCPs认为主流化有帮助（之后为94%，之前为81%，p = 0.01）。感知知识和实际知识均显著增加。82%的ngHCPs进行检测前遗传咨询的时间不到10分钟，大多数（88%）支持继续采用主流化途径。只有6名参与的ngHCPs认为不预先完成培训模块也可以实现主流化。
结论
完成一个简短的在线培训模块后，ngHCPs感觉已做好充分准备，能够与转移性前列腺癌患者讨论胚系基因检测。
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