Addressing the critical need for cancer genetic evaluation by implementation of an embedded coordinator-based...

Area of Science:

• Oncology
• Genetics
• Healthcare Delivery Models

Background:

• Increasing indications for germline genetic testing (GT) for hereditary cancer predispositions are straining resources.
• A critical shortage of genetic counselors (GCs) necessitates innovative alternative delivery models for genetic services.
• The Smilow Cancer Genetics and Prevention Program (SCGP) sought to improve efficiency in GT.

Purpose of the Study:

• To design, implement, and evaluate a coordinator-based alternative GT delivery model, the Fast-Track Program.
• To assess the impact of the Fast-Track Program on reducing wait times for GT appointments.
• To ensure standard-of-care delivery for cancer GT under GC oversight within the new model.

Main Methods:

• Implemented a Fast-Track Program utilizing trained clinical genetics coordinators (GCCs) for pre-test education and GT coordination.
• GCs triaged referrals based on National Comprehensive Cancer Network (NCCN) guidelines.
• Patients received an educational video, and GCCs coordinated testing; GCs reviewed all cases post-visit for management recommendations.

Main Results:

• The Fast-Track Program saw 415 patients over 9 months, with 12.3% identifying pathogenic/likely pathogenic variants (PGVs).
• Mean days from referral to appointment were significantly shorter in the Fast-Track program (21.92 days) compared to the standard GC pipeline (90.14 days) (p < 0.001).
• GCs managed complex results or PGVs, while GCCs handled disclosure for uncomplicated cases.

Conclusions:

• A coordinator-based genetics delivery model successfully expedited GT visits and is expanding.
• GC oversight is crucial for maintaining standard-of-care in cancer GT within this model.
• Further evaluation of outcomes like patient satisfaction is needed to fully contextualize the model's impact.