Highlights
- •Dissemination of genetics quality improvement to a county hospital was feasible.
- •Uptake of recommended genetic services increased to >80% by the end of 26 months.
- •The time between cancer diagnosis and receipt of genetic services decreased.
- •In this diverse, indigent population, 23% of tested patients had germline mutations.
Abstract
Objective
The universal genetic testing initiative (UGTI) is a quality improvement effort to
increase rates of guideline-based genetic counseling (GC) and genetic testing (GT)
of patients with potentially hereditary cancers. The UGTI was disseminated to a county
hospital gynecologic oncology clinic that serves a diverse, indigent patient population.
Methods
Using the Model for Improvement quality improvement framework, interventions including
integrated GC, clinic tracking, assisted GC referrals, and provider education were
tested over 26 months. A retrospective data review included patients with high-grade,
non-mucinous epithelial ovarian, fallopian tube, and primary peritoneal cancers (HGOC)
and endometrial cancers (EC) diagnosed between 9/1/12–8/31/16. Statistical analyses
were performed to describe the population and to evaluate rates of recommendation
and use of immunohistochemistry tumor testing (IHC), GC, and GT.
Results
A cohort of 241 patients (57 HGOC, 184 EC) were included. At the conclusion of the
study 84.2% of HGOC patients were referred for GC, 89.6% (43/48) completed GC, and
90.7% (39/43) completed GT. Of EC patients, 81.0% were recommended to have IHC and
62.4% (93/149) completed IHC. Patients with HGOC diagnosed during dissemination of
UGTI were significantly more likely to receive a recommendation for GC (p = 0.02) and to complete GT (p = 0.03) than those diagnosed before UGTI. Patients with EC were significantly more
likely to complete IHC if diagnosed after UGTI than those diagnosed prior to dissemination
(p < 0.001).
Conclusions
The UGTI can be adapted to increase use of guideline-based cancer genetics services
in a diverse, indigent, gynecologic cancer patient population.
Keywords
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Article info
Publication history
Published online: December 08, 2018
Accepted:
December 1,
2018
Received in revised form:
November 28,
2018
Received:
October 22,
2018
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
