Oncology Clinic-Based Hereditary Cancer Genetic Testing in a Population-Based Health Care System

New streamlined models for genetic counseling and genetic testing have recently been developed in response to increasing demand for cancer genetic services. To improve access and decrease wait times, we implemented an oncology clinic-based genetic testing model for breast and ovarian cancer patients in a publicly funded population-based health care setting in British Columbia, Canada. This observational study evaluated the oncology clinic-based model as compared to a traditional one-on-one approach with a genetic counsellor using a multi-gene panel testing approach. The primary objectives were to evaluate wait times and patient reported outcome measures between the oncology clinic-based and traditional genetic counselling models. Secondary objectives were to describe oncologist and genetic counsellor acceptability and experience. Wait times from referral to return of genetic testing results were assessed for 400 patients with breast and/or ovarian cancer undergoing genetic testing for hereditary breast and ovarian cancer from June 2015 to August 2017. Patient wait times from referral to return of results were significantly shorter with the oncology clinic-based model as compared to the traditional model (403 vs. 191 days; p < 0.001). A subset of 148 patients (traditional n = 99; oncology clinic-based n = 49) completed study surveys to assess uncertainty, distress, and patient experience. Responses were similar between both models. Healthcare providers survey responses indicated they believed the oncology clinic-based model was acceptable and a positive experience. Oncology clinic-based genetic testing using a multi-gene panel approach and post-test counselling with a genetic counsellor significantly reduced wait times and is acceptable for patients and health care providers.


Decision uncertainty
This decision is hard for me to make  (are about to make/just made), please look at the following comments some people make when deciding about (treatment, screening, etc.). Please, show how strongly you agree or disagree with these comments by CIRCLING THE NUMBER from 1 (strongly agree) to 5 (strongly disagree) that best shows how you feel about the decision you (are about to make/just made).

The Multidimensional Impact of Cancer Risk Assessment (MICRA) Questionnaire
The statements below are about some specific responses you may have had after receiving your genetic test results. Please answer every question in Section 1, regardless of whether you were given a positive or negative test result. Please indicate whether you have experienced each statement never, rarely, sometimes, or often in the past week, by circling the corresponding number.

1.
A woman who does not have an altered gene can still get breast or ovarian cancer T F 2.
A woman who has an altered gene has an increased risk of ovarian cancer T F 3.
A woman who has her breasts removed can still get breast cancer T F 4.
A woman who has a sister with an altered breast-ovarian cancer gene has a 50% chance (1 in 2) of also having an altered gene T F

5.
Tests for ovarian cancer often do not detect a tumour until after it has spread T F 6.
A father can pass down an altered breast-ovarian cancer gene to his daughter T F 7.
All women who have an altered breast-ovarian cancer gene will get breast cancer T F 8.
Early onset breast cancer is less likely to be due to an altered gene than late onset breast cancer T F 9. About one-half of all cases of breast cancer in the United States occur in women who inherited an altered breast-ovarian cancer gene* T F

10.
Having one's ovaries removed will definitely prevent ovarian cancer T F 11.
About one in ten women have an altered breast-ovarian cancer gene T F * Question 9 was left as-is and not altered to replace "United States" with "Canada"  You have now completed this questionnaire.
I believe it is important for breast and ovarian cancer patients to be able to benefit from multi-panel gene testing. 1 2 3 4 5 2.
There is an increasing interest from breast and ovarian cancer patients to have multi-panel gene testing. 1 2 3 4 5 3.
I welcome the opportunity to carry out multi-panel gene tests for breast and ovarian cancer patients through oncology appointments. 1 2 3 4 5 4.
I found it helpful to have supporting material (e.g. training materials and FAQs) containing information on the process of multi-panel gene testing. 1 2 3 4 5 5.
It was useful to be able to complete the multi-panel gene testing training materials at a time that was convenient to me. 1 2 3 4 5 6.
It is useful to have an approved clinical protocol to follow when obtaining consent from patients for multi-panel gene testing. 1 2 3 4 5 7.
It is useful to have information sheets to provide to patients about multi-panel gene testing. 1 2 3 4 5 8.
I feel confident to consent a patient for multi-panel gene testing. 1 2 3 4 5 9.
It is possible to discuss multi-panel gene testing with a patient within the timeframe of a consultation. 1 2 3 4 5 10.
I was clear when the results from the multi-panel gene test would be available. 1 2 3 4 5 11.
The process for carrying out multi-panel gene testing worked well. 1 2 3 4 5 Figure 6. Oncologist Survey.