Highlights
- •Oncology professionals are willing to be involved in mainstreaming genetic testing for women with ovarian cancer.
- •Formal training in mainstreaming genetic testing decreases perceived barriers.
- •Training alone does not address all barriers to mainstreaming testing of BRCA1/2.
Abstract
Background
BRCA1/2 mutation status has increasing relevance for ovarian cancer treatments, making traditional
coordination of genetic testing by genetic services unsustainable. Consequently alternative
models of genetic testing have been developed to improve testing at the initial diagnosis
for all eligible women.
Methods
A training module to enable mainstreamed genetic testing by oncology healthcare professionals
was developed by genetic health professionals. Oncology healthcare professionals completed
questionnaires before and 12 months post-training to assess perceived skills, competence
and barriers to their coordinating genetic testing for women with high-grade non-mucinous
epithelial ovarian cancer. Genetic health professionals were surveyed 12 months post-training
to assess perceived barriers to implementation of mainstreaming.
Results
185 oncology healthcare professionals were trained in 42 workshops at 35 Australasian
hospitals. Of the 273 tests ordered by oncology healthcare professionals post-training,
241 (93.1%) met national testing guidelines. The number of tests ordered by genetic
health professionals reduced significantly (z = 45.0, p = 0.008). Oncology healthcare professionals' perceived barriers to mainstreamed testing
decreased from baseline to follow-up (t = 2.39, p = 0.023), particularly perceived skills, knowledge and attitudes. However, only 58%
reported either ‘always’ or ‘nearly always’ having ordered BRCA testing for eligible patients at 12 months, suggesting oncology healthcare professionals'
perceived barriers were not systematically addressed through training.
Conclusions
Oncology healthcare professionals have demonstrated a willingness to be involved in
the provision of genetic testing in a mainstreaming model. If oncology services are
to hold responsibility for coordinating genetic testing, their readiness will require
understanding of barriers not addressed by training alone to inform future intervention
design.
Keywords
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References
- Maintenance olaparib in patients with newly diagnosed advanced ovarian cancer.N. Engl. J. Med. 2018; 379: 2495-2505
- Olaparib tablets as maintenance therapy in patients with platinum- sensitive, relapsed ovarian cancer and a BRCA1/2 mutation (SOLO2/ENGOT-Ov21): a double-blind, randomised, placebo-controlled, phase 3 trial.Lancet. 2017; 8: 1274-1284
- Niraparib maintenance therapy in platinum-sensitive, recurrent ovarian cancer.N. Engl. J. Med. 2016; 375: 2154-2164
- deFazio A, Emmanuel C, George J, et al. BRCA mutation frequency and patterns of treatment response in BRCA mutation positive women with ovarian cancer.J. Clin. Oncol. 2012; 30: 2654-2663
Cancer Institute of New South Wales. www.eviq.org.au.
Kentwell, Dow E, Y A, Wrede C, McNally O, Higgs E, et al. Mainstreaming cancer genetics: A model integrating germline BRCA testing into routine ovarian cancer clinics. Gynecol Oncol. 2017;145:130–6.
Tutty E, Petelin L, McKinley J, Young M, Meiser B, Rasmussen V, et al. Evaluation of telephone genetic counselling to facilitate germline BRCA1/2 testing in women with high-grade serious ovarian cancer. Accepted by the European Journal of Human Genetics on 19 March 2019.
- Implementing rapid, robust, cost-effective, patient-centred, routine genetic testing in ovarian cancer patients.Sci. Rep. 2016; 6: 29506
- Evaluation of a streamlined oncologist-led BRCA mutation testing and counseling model for patients with ovarian Cancer.J. Clin. Oncol. 2018; 6: 1300-1307
- The integration of BRCA testing into oncology clinics.Br. J. Nurs. 2016; 25: 690-694
- Uptake of testing for germline BRCA mutations in patients with non-mucinous epithelial ovarian cancers in Western Australia: a comparison of different genetic counseling methods.Int J Gynaecol Cancer. 2019; 29: 1038-1042
- Streamlined education is effective for women newly diagnosed with breast cancer considering genetic testing.Genet Med. 2017; 19: 448-456
- What women want: communication and information needs of women newly diagnosed with ovarian cancer regarding treatment focused genetic testing.Oncol. Nurs. Forum. 2013; 40: 275-283
- Development of cancer genetic services in the UK: a national consultation.Genome Medicine. 2015; 7: 18
- Development and initial validation of the Influences on Patient Safety Behaviours Questionnaire.Implement. Sci. 2013; 8: 81
- Making psychological theory useful for implementing evidence based practice: a consensus approach.Quality and Safety in Health Care. 2005; 14: 26-33
- The effectiveness of recruitment strategies on general practitioner’s survey response rates – a systematic review.BMC Med. Res. Methodol. 2014; 14
Cho Y, Johnson T, VanGeest J. Enhancing Surveys of Health Care Professionals: A Meta-Analysis of Techniques to Improve Response Evaluation and the Health Professions. 2013;36:382–407.
- Getting physicians to respond: the impact of incentive type and timing on physician survey response rates.Health Services Ressearch. 2011; 46: 232-242
- Data management and analysis methods. In: Denzin N, LIncoln Y, Editors. Handbook of Qualittaive Analysis. 2nd Edition Ed.Sage Publications, Thousand Oakes, California2000
- Statistical Power Analysis for the Behavioural Sciences. 2nd Edition Ed.Academic Press, New York1988
- Moving into the mainstream: healthcare professionals’ views of implementing treatment focussed genetic testing in breast cancer care.Familial Cancer. 2019; 18: 293-301
- Mainstreamed genetic testing for women with ovarian cancer: first-year experience.J. Med. Genet. 2019; 56: 195-198
- Health professionals’ evaluation of delivering treatment-focused genetic testing to women newly diagnosed with breast cancer.Familial Cancer. 2015; 14: 265-272
Westbrook J, Reckmann M, Ling L, William B, Runciman R, Burke C, et al. Effects of Two Commercial Electronic Prescribing Systems on Prescribing Error Rates in Hospital In-Patients: A Before and After Study PLOS Medicine. 2012;9:e1001164.
Article info
Publication history
Published online: May 22, 2020
Accepted:
May 3,
2020
Received:
January 21,
2020
Footnotes
☆The additional members of the Australian Genetic Testing Mainstreaming Collaborative Group are Jacquie Armstrong and Debra Trott, South Australian Clinical Genetics Services, Adelaide.
Identification
Copyright
Crown Copyright © 2020 Published by Elsevier Inc. All rights reserved.
