Title : Nurse coordinator supported outreach to patient decliners within a genetic testing program for individuals at-risk for hereditary breast/ovarian cancer
Abstract:
Background: A percentage of breast/ovarian cancers are due to hereditary pathogenic genetic variants. Individuals with a family history of breast, ovarian, pancreatic, prostate or colon cancer(s) may be at risk for developing cancer themselves, if a pathogenic genetic variant is present. Genetic testing at-risk individuals offers an opportunity to identify pathogenic genetic variant(s). Knowing this information can guide monitoring activities (such as imaging or testing) as well as inform prophylactic approaches and may result in cancer being detected early or avoided entirely in some individuals. Previous research conducted within our health care delivery system indicated that repeated contact to patients eligible for genetic testing was acceptable. Methods: Kaiser Permanente Mid-Atlantic States (KPMAS) implemented an electronic health record (EHR)-based alert to identify at-risk individuals due to their documented family history and refer to genetic counseling. Patients who declined the genetics referral or missed their genetics visit were outreached to through a Nurse Coordinator supported telemedicine-based outreach process that included patient portal messages, electronic scheduling tickets, a patient-facing electronic questionnaire, and a Nurse Coordinator providing telephone-based reminders and care coordination support. Results: Among the 5,466 patients who had the EHR based alert acknowledged by the physician, 51% (n=2,769) accepted the genetics referral, and 27% (n=1,480) completed the genetics visit, and 5.5% (n=301) completed genetic testing. Nurse Coordinator supported outreach to decliners (n=1,508) resulted in an additional 108 patients completing genetic testing, indicating the additional outreach to patient-decliners increased overall testing by 36%. In total, 409 patients completed genetic testing and 28 pathogenic genetic variants were identified. Conclusions: A nurse coordinator supported outreach program can increase genetic testing among patients who previously declined.
Audience Take Away:
- Audience members will understand the duties of a Nurse Coordinator providing virtual support within the context of a population-wide genetic testing program for at-risk individuals
- Audience members will be able to identify areas within a genetic testing workflow where Nurse Coordinators can offer virtual care coordination support to ensure patients complete the testing process
- Audience members will understand the patient perspective and attitudes towards a genetic testing program that includes Nurse Coordinators
- Audience members could use this research to inform the design of Coordinator-supported genetic testing workflows for patients at-risk due to family history. This is important as population-wide genetic testing rises in popularity
- Audience members will gain practical tips on using Nurse Coordinators as part of primary care and specialty departments
- Audience members will gain practical tips on how virtual staff and tools, such as patient portal messages, electronic scheduling tickets, a patient-facing electronic questionnaire, and a Nurse Coordinator providing telephone-based reminders can support patient care
