lunes, 24 de junio de 2013

A cancer genetics toolkit improves access to genetic services through documentation and use of the family history by primary-care clinicians : Genetics in Medicine : Nature Publishing Group

A cancer genetics toolkit improves access to genetic services through documentation and use of the family history by primary-care clinicians : Genetics in Medicine : Nature Publishing Group

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

Genetics in Medicine



Published online



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.


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).


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).


A multicomponent approach to the systematic collection and use of family history by primary-care clinicians increased access to genetic services.

Genet Med advance online publication 13 June 2013


family history; hereditary cancer; referral


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Author information


  1. VA Greater Los Angeles Healthcare System, Los Angeles, California, USA

    • Maren T. Scheuner,

    • Alison B. Hamilton,

    • Jane Peredo,

    • Taylor J. Sale,

    • Colletta Austin,

    • Caroline Lubick Goldzweig,

    • Martin Lee,

    • Brian S. Mittman &

    • Elizabeth M. Yano

  2. Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA

    • Maren T. Scheuner &

    • Caroline Lubick Goldzweig

  3. Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California, USA

    • Alison B. Hamilton

  4. Office of Academic Affiliations, Veterans Health Administration, Washington DC, USA

    • Stuart C. Gilman

  5. Office of Public Health Genomics, Centers for Disease Control and Prevention, Atlanta, Georgia, USA

    • M. Scott Bowen

  6. UCLA Fielding School of Public Health, Los Angeles, California, USA

    • Martin Lee &

    • Elizabeth M. Yano

Corresponding author

Correspondence to:

Supplementary information

PDF files

  1. Supplementary Data S1 (205 KB)

  2. Supplementary Data S2 (130 KB)

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