Title : The impact of nurse coordinators on a traceback cascade genetic testing program for ovarian cancer
Abstract:
Background: Ovarian cancer has vague symptoms and is often diagnosed at late stages, which results in high mortality. A proportion of breast/ovarian cancers are due to hereditary pathogenic genetic variants. Genetic testing of cancer patients offers an opportunity to determine if there is a pathogenic genetic variant in the family. If a pathogenic variant is found, offering cascade genetic testing to family members can identify others at-risk. Knowing this information can positively impact the care of the cancer patient and cancer may be avoided in some at-risk family members. The concept of identifying and genetically testing previously diagnosed ovarian cancer survivors to identify at-risk families is termed “Traceback.” Methods: As part of a National Cancer Institute-funded cooperative agreement, Kaiser Permanente Mid-Atlantic States (KPMAS), Geisinger Health System, and Kaiser Permanente Washington (KPW) have designed and are evaluating Traceback testing programs in the clinical environment. The KPMAS model used nurse navigators to support the Traceback testing program. Nurse Coordinators practicing virtually supported cancer patient outreach, genetic test ordering, and downstream care coordination. Results: Within the KPMAS program, 224 patients were eligible for genetic testing, 153 (68%) of patients were reached by Nurse Coordinators, 123 (80%) of patients agreed to receive a mailed saliva genetic test kit after speaking with the Nurse Coordinator, 2 (1%) patients requested a genetic counseling visit, 74 (60%) of patients completed genetic testing. 9.4% (n=7) of patients had pathogenic genetic variants, 30% (n=22) variants of uncertain significance, and 61% negative (n=45). Semi-structured interviews with patients who participated in the Traceback program revealed that participants felt the Nurse Coordinator involvement was positive and helpful. Conclusions: The use of Nurse Coordinators as part of a Traceback testing program is feasible and acceptable. Most patients agreed to genetic testing after a conversation with the Nurse Coordinator, without the need to complete a genetic counseling visit. This program demonstrates that a Traceback genetic testing program can be effectively supported by Nurse Coordinators, which offers another option for settings where genetic counselors and/or genetic counseling access is more limited.
Audience Take Away:
- Audience members will understand the duties of a Nurse Coordinator within the context of a Traceback genetic testing program for ovarian cancer.
- Audience members will be able to identify areas within a genetic testing workflow where Nurse Coordinators and Genetic Counselors can each manage steps 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, which is particularly important in geographic areas where genetic counselor access is limited. This is a practical solution to the pressing problem of limited genetic counselor availability and access nationwide.
- Audience members will gain practical tips on using Nurse Coordinators as part of comprehensive cancer patient care.
- Audience members will gain practical tips on how to use Nurse Coordinators virtually to support patient care.
