将乳腺癌患者的遗传检测和咨询整合到一个大型的多站点社区实践中
Molly A Mendenhall1, Andrew Guinigundo2, Dan Davies1
1Oncology Hematology Care (OHC), Cincinnati, OH.
JCO oncology practice
|June 27, 2023
概括
实施国家综合癌症网络 (NCCN) 准则和电子健康记录 (EHR) 改进显著提高了乳腺癌患者同源重组缺陷 (HRD) /BRCA测试率. 这一举措提高了社区瘤实践中的基因查遵守率和转诊率.
科学领域:
- 在瘤学瘤学.
- 遗传学 是一个遗传学.
- 医疗保健信息学 医疗保健信息学
背景情况:
- 尽管已经制定了指导方针,但对乳腺癌患者的基因查和检测仍然存在显著的不遵守.
- 只有35%的乳腺癌患者有资格接受同源复合缺陷 (HRD) /BRCA测试,被转诊接受遗传咨询.
- 每年诊断出超过30万例乳腺癌病例,其中三分之一符合NCCN遗传检测标准.
研究的目的:
- 通过将NCCN指南应用于社区瘤学环境中的新乳腺癌患者来提高HRD/BRCA测试率.
- 改善乳腺癌患者对生殖基因检测协议的遵守.
- 简化基因咨询和测试的转诊过程.
主要方法:
- 利用计划-做-研究-行动方法来实施NCCN关于生殖基因测试的指导方针.
- 综合提供者教育和电子健康记录 (EHR) 模板,用于初始诊断和治疗计划.
- 在EHR中开发了谨慎的数据字段,以自动化和简化患者查和转诊.
主要成果:
- 99%的符合条件的乳腺癌患者 (1,200/1,203) 根据NCCN指南进行了查.
- 52.5%的查患者 (631/1,200) 符合转诊/测试标准,其中92.7% (585/631) 被转诊给遗传学专家.
- 71%的符合条件的患者 (449/631) 接受了遗传转诊,表明参与度有所改善.
结论:
- 提供者教育,EHR整合和指南实施有效地增加了患者查和遗传转诊.
- 这项研究展示了一个成功的模型,用于改善社区瘤学中对遗传测试的遵守.
- 系统地应用指导方针和技术改进可以克服乳腺癌护理中基因测试的障碍.
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