lunes, 24 de junio de 2013

A cancer genetics toolkit improves access to genetic services through documentation and use of the family history by primary-care clinicians : Genetics in Medicine : Nature Publishing Group

A cancer genetics toolkit improves access to genetic services through documentation and use of the family history by primary-care clinicians : Genetics in Medicine : Nature Publishing Group


A cancer genetics toolkit improves access to genetic services through documentation and use of the family history by primary-care clinicians




Genetics in Medicine
(2013)
doi:10.1038/gim.2013.75


Received


Accepted


Published online




Abstract




Purpose:



We developed, implemented, and evaluated a multicomponent cancer genetics toolkit designed to improve recognition and appropriate referral of individuals at risk for hereditary cancer syndromes.


Methods:



We evaluated toolkit implementation in the women’s clinics at a large Veterans Administration medical center using mixed methods, including pre–post semistructured interviews, clinician surveys, and chart reviews, and during implementation, monthly tracking of genetic consultation requests and use of a reminder in the electronic health record. We randomly sampled 10% of progress notes 6 months before (n = 139) and 18 months during implementation (n = 677).


Results:



The toolkit increased cancer family history documentation by almost 10% (26.6% pre- and 36.3% postimplementation). The reminder was a key component of the toolkit; when used, it was associated with a twofold increase in cancer family history documentation (odds ratio = 2.09; 95% confidence interval: 1.39–3.15), and the history was more complete. Patients whose clinicians completed the reminder were twice as likely to be referred for genetic consultation (4.1–9.6%, P < 0.0001).


Conclusion:



A multicomponent approach to the systematic collection and use of family history by primary-care clinicians increased access to genetic services.

Genet Med advance online publication 13 June 2013

View full text



Keywords:


family history; hereditary cancer; referral





References




  1. National Comprehensive Cancer Network. Clinical Practice Guidelines in Oncology. Genetic/Familial High-Risk Assessment: Breast and Ovarian. Version I.2011 7 April 2011. http://www.nccn.org/professionals. Accessed 20 November 2012.

  2. National Comprehensive Cancer Network. Clinical Practice Guidelines in Oncology. Colorectal cancer screening. Version 2.2011, 22 October 2010. http://www.nccn.org/professionals. Accessed 20 November 2012.

  3. Sardanelli F, Podo F, Santoro F, et al.; High Breast Cancer Risk Italian 1 (HIBCRIT-1) Study. Multicenter surveillance of women at high genetic breast cancer risk using mammography, ultrasonography, and contrast-enhanced magnetic resonance imaging (the high breast cancer risk Italian 1 study): final results. Invest Radiol 2011;46:94–105.

  4. Huang M, Sun C, Boyd-Rogers S, et al. Prospective study of combined colon and endometrial cancer screening in women with lynch syndrome: a patient-centered approach. J Oncol Pract 2011;7:43–47.

  5. Rebbeck TR, Lynch HT, Neuhausen SL, et al.; Prevention and Observation of Surgical End Points Study Group. Prophylactic oophorectomy in carriers of BRCA1 or BRCA2 mutations. N Engl J Med 2002;346:1616–1622.

  6. Rebbeck TR, Friebel T, Lynch HT, et al. Bilateral prophylactic mastectomy reduces breast cancer risk in BRCA1 and BRCA2 mutation carriers: the PROSE Study Group. J Clin Oncol 2004;22:1055–1062.

  7. Eisen A, Lubinski J, Klijn J, et al. Breast cancer risk following bilateral oophorectomy in BRCA1 and BRCA2 mutation carriers: an international case-control study. J Clin Oncol 2005;23:7491–7496.

  8. Järvinen HJ, Aarnio M, Mustonen H, et al. Controlled 15-year trial on screening for colorectal cancer in families with hereditary nonpolyposis colorectal cancer. Gastroenterology 2000;118:829–834.

  9. Schmeler KM, Lynch HT, Chen LM, et al. Prophylactic surgery to reduce the risk of gynecologic cancers in the Lynch syndrome. N Engl J Med 2006;354:261–269.

  10. Narod SA, Brunet JS, Ghadirian P, et al.; Hereditary Breast Cancer Clinical Study Group. Tamoxifen and risk of contralateral breast cancer in BRCA1 and BRCA2 mutation carriers: a case-control study. Hereditary Breast Cancer Clinical Study Group. Lancet 2000;356:1876–1881.

  11. Chan AT, Lippman SM. Aspirin and colorectal cancer prevention in Lynch syndrome. Lancet 2011;378:2051–2052.

  12. U.S. Preventive Services Task Force. Genetic risk assessment and BRCA mutation testing for breast and ovarian cancer susceptibility: recommendation statement. Ann Intern Med 2005;143:355–361.

  13. Evaluation of Genomic Applications in Practice and Prevention (EGAPP) Working Group. Recommendations from the EGAPP Working Group: genetic testing strategies in newly diagnosed individuals with colorectal cancer aimed at reducing morbidity and mortality from Lynch syndrome in relatives. Genet Med 2009;11:35–41.

  14. Bellcross CA, Kolor K, Goddard KA, Coates RJ, Reyes M, Khoury MJ. Awareness and utilization of BRCA1/2 testing among U.S. primary care physicians. Am J Prev Med 2011;40:61–66.

  15. Baer HJ, Brawarsky P, Murray MF, Haas JS. Familial risk of cancer and knowledge and use of genetic testing. J Gen Intern Med 2010;25:717–724.

  16. Trivers KF, Baldwin LM, Miller JW, et al. Reported referral for genetic counseling or BRCA 1/2 testing among United States physicians: a vignette-based study. Cancer 2011;117:5334–5343.

  17. Scheuner MT, Sieverding P, Shekelle PG. Delivery of genomic medicine for common chronic adult diseases: a systematic review. JAMA 2008;299:1320–1334.

  18. Burke W, Culver J, Pinsky L, et al. Genetic assessment of breast cancer risk in primary care practice. Am J Med Genet A 2009;149A:349–356.

  19. Brierley KL, Campfield D, Ducaine W, et al. Errors in delivery of cancer genetics services: implications for practice. Conn Med 2010;74:413–423.

  20. United Healthcare Center for Health Reform & Modernization. Personalized medicine: Trends and prospects for the new science of genetic testing and molecular diagnostics. Working Paper 7 March 2012, p 23. http://www.unitedhealthgroup.com/hrm/UNH_WorkingPaper7.pdf. Accessed 6 May 2012.

  21. Curran GM, Mukherjee S, Allee E, Owen RR. A process for developing an implementation intervention: QUERI Series. Implement Sci 2008;3:17.

  22. Mazmanian PE, Davis DA. Continuing medical education and the physician as a learner: guide to the evidence. JAMA 2002;288:1057–1060.

  23. Oxman AD, Thomson MA, Davis DA, Haynes RB. No magic bullets: a systematic review of 102 trials of interventions to improve professional practice. CMAJ 1995;153:1423–1431.

  24. Mansouri M, Lockyer J. A meta-analysis of continuing medical education effectiveness. J Contin Educ Health Prof 2007;27:6–15.

  25. Khoury MJ, Coates RJ, Fennell ML, et al. Multilevel research and the challenges of implementing genomic medicine. J Natl Cancer Inst Monographs 2012;2012:112–120.

  26. Yano EM, Washington DL, Goldzweig C, Caffrey C, Turner C. The organization and delivery of women’s health care in Department of Veterans Affairs Medical Center. Womens Health Issues 2003;13:55–61.

  27. Yano EM, Goldzweig C, Canelo I, Washington DL. Diffusion of innovation in women’s health care delivery: the Department of Veterans Affairs’ adoption of women’s health clinics. Womens Health Issues 2006;16:226–235.

  28. Richards T, Richards L. Using hierarchical categories in qualitative data analysis. In: Kelly U (ed). Computer-Aided Qualitative Data Analysis. Theory, Methods, and Practice. Sage: London, 1995:80–95.

  29. Evans DC, Nichol WP, Perlin JB. Effect of the implementation of an enterprise-wide Electronic Health Record on productivity in the Veterans Health Administration. Health Econ Policy Law 2006;1(Pt 2):163–169.

  30. Scheuner MT, Wang SJ, Raffel LJ, Larabell SK, Rotter JI. Family history: a comprehensive genetic risk assessment method for the chronic conditions of adulthood. Am J Med Genet 1997;71:315–324.

  31. Scheuner MT, McNeel TS, Freedman AN. Population prevalence of familial cancer and common hereditary cancer syndromes. The 2005 California Health Interview Survey. Genet Med 2010;12:726–735.

  32. Kawamoto K, Houlihan CA, Balas EA, Lobach DF. Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success. BMJ 2005;330:765.

  33. Qureshi N, Carroll JC, Wilson B, et al. The current state of cancer family history collection tools in primary care: a systematic review. Genet Med 2009;11:495–506.

  34. Murff HJ, Byrne D, Haas JS, Puopolo AL, Brennan TA. Race and family history assessment for breast cancer. J Gen Intern Med 2005;20:75–80.

  35. Armstrong K, Micco E, Carney A, Stopfer J, Putt M. Racial differences in the use of BRCA1/2 testing among women with a family history of breast or ovarian cancer. JAMA 2005;293:1729–1736.

  36. Levy DE, Byfield SD, Comstock CB, et al. Underutilization of BRCA1/2 testing to guide breast cancer treatment: black and Hispanic women particularly at risk. Genet Med 2011;13:349–355.

  37. Feero WG. Genetics of common disease: a primary care priority aligned with a teachable moment? Genet Med 2008;10:81–82.

  38. Medalie JH, Zyzanski SJ, Langa D, Stange KC. The family in family practice: is it a reality? J Fam Pract 1998;46:390–396.



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Author information





Affiliations




  1. VA Greater Los Angeles Healthcare System, Los Angeles, California, USA



    • Maren T. Scheuner,

    • Alison B. Hamilton,

    • Jane Peredo,

    • Taylor J. Sale,

    • Colletta Austin,

    • Caroline Lubick Goldzweig,

    • Martin Lee,

    • Brian S. Mittman &

    • Elizabeth M. Yano




  2. Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA



    • Maren T. Scheuner &

    • Caroline Lubick Goldzweig




  3. Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California, USA



    • Alison B. Hamilton




  4. Office of Academic Affiliations, Veterans Health Administration, Washington DC, USA



    • Stuart C. Gilman




  5. Office of Public Health Genomics, Centers for Disease Control and Prevention, Atlanta, Georgia, USA



    • M. Scott Bowen




  6. UCLA Fielding School of Public Health, Los Angeles, California, USA



    • Martin Lee &

    • Elizabeth M. Yano







Corresponding author



Correspondence to:






Supplementary information



PDF files





  1. Supplementary Data S1 (205 KB)






  2. Supplementary Data S2 (130 KB)




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