Evaluating and improving the implementation of a community-based hereditary cancer screening program
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Healthcare disparities exist in the provision of cancer genetic services including genetic counseling and testing related to BRCA1/2 mutations. To address this in a community health setting a screening tool was created to identify high-risk women. This study evaluates the implementation of the tool and identifies opportunities for improved cancer genetic screening, including regular clinician education. A mixed-method approach was used to evaluate clinician utilization of the screening tool at Planned Parenthood affiliates. Novel surveys that evaluated acceptance and implementation were administered to clinicians (n = 14) and semi-structured interviews (n = 6) were used to explore clinicians’ perspectives and identify gaps in its utilization. Educational modules that addressed gaps were developed, implemented, and evaluated using a post-education survey (n = 8). Clinicians reported confidence in administering and interpreting the screening tool, but reported less confidence in their knowledge of cancer genetics and ability to connect clients with genetic counseling and testing (p = .003). Educational modules resulted in significant gains in clinician knowledge on genetic topics (p < .05) and increased self-reported confidence in connecting clients with genetic services. The modules reinforced the belief that genetic testing is beneficial for patients at increased risk (p = .001) and is important to inform subsequent medical management (p = .027). While building community clinicians’ capacity to connect clients with genetic services is crucial, it is challenged by knowledge and confidence gaps in discussions of genetic services with clients. Consistent genetic-focused education with non-genetic clinicians can improve confidence and knowledge, enabling a more effective screening program in community health settings.
KeywordsBRCA1/2 mutations Cancer genetic services Cancer risk evaluation Access to genetic services Genetic education Medically underserved populations
The authors on this paper would like to thank the Planned Parenthood Federation of America staff (Deborah Nucatola, Courtney Benedict, Zoe Unger, and Karen Shea) and Mary Kint Petit at Planned Parenthood of Mid and South Michigan for their support of this research. Additionally, many thanks are extended to the organizations and individuals that created the resources used for the educational webinars including the American Cancer Society, Dr. Cecilia Bellcross, MySupport360 Hereditary Cancer, Kara Milliron, Chris Chapman, and Marc Stephens. A large thank you is also extended to Ilana Miller for her transcription work.
Partial funding for this project was provided by the National Society of Genetic Counselors Education Special Interest Group and the University of Michigan Genetic Counseling Research Grant.
Compliance with ethical standards
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 (5). Informed consent was obtained from all patients for being included in the study, per exempt approval of University of Michigan IRB HUM00090186.
Conflict of interest
The authors declare that they have no conflict of interest.
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