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

作者：Scheuner Maren T^*; Hamilton Alison B; Peredo Jane; Sale Taylor J; Austin Colletta; Gilman Stuart C; Bowen M Scott; Goldzweig Caroline Lubick; Lee Martin; Mittman Brian S; Yano Elizabeth M

来源：Genetics in Medicine, 2014, 16(1): 60-69.

DOI：10.1038/gim.2013.75

• family history
• hereditary cancer
• referral

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.

• 出版日期2014-1