domingo, 23 de diciembre de 2018

Disseminating universal genetic testing to a diverse, indigent patient population at a county hospital gynecologic oncology clinic. - PubMed - NCBI

2018 Dec 8. pii: S0090-8258(18)31457-4. doi: 10.1016/j.ygyno.2018.12.001. [Epub ahead of print]

Disseminating universal genetic testing to a diverse, indigent patient population at a county hospital gynecologic oncology clinic.

Bednar EM1, Sun CC2, Camacho B2, Terrell J3, Rieber AG4, Ramondetta LM2, Freedman RS2, Lu KH2.

Author information

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).