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Genet Med. 2014 Oct;16(10):773-82. doi: 10.1038/gim.2014.31. Epub 2014 Mar 20.

Comparing universal Lynch syndrome tumor-screening programs to evaluate associations between implementation strategies and patient follow-through.

Author information

1
Division of Population Science, Moffitt Cancer Center, Tampa, Florida, USA.
2
Department of Community and Family Health, University of South Florida, Tampa, Florida, USA.
3
Department of Internal Medicine, Ohio State University, Columbus, Ohio, USA.

Abstract

PURPOSE:

Universal tumor screening (UTS) for all colorectal cancer patients can improve the identification of Lynch syndrome, the most common cause of hereditary colorectal cancer. This multiple-case study explored how variability in UTS procedures influenced patient follow-through (PF) with germ-line testing after a screen-positive result.

METHODS:

Data were obtained through Web-based surveys and telephone interviews with institutional informants. Institutions were categorized as Low-PF (≤10% underwent germ-line testing), Medium-PF (11-40%), or High-PF (>40%). To identify implementation procedures (i.e., conditions) unique to High-PF institutions, qualitative comparative analysis was performed.

RESULTS:

Twenty-one informants from 15 institutions completed surveys and/or interviews. Conditions present among all five High-PF institutions included the following: (i) disclosure of screen-positive results to patients by genetic counselors; and (ii) genetic counselors either facilitate physician referrals to genetics professionals or eliminate the need for referrals. Although both of these High-PF conditions were present among two Medium-PF institutions, automatic reflex testing was lacking and difficulty contacting screen-positive patients was a barrier. The three remaining Medium-PF and five Low-PF institutions lacked the conditions found in High-PF institutions.

CONCLUSION:

METHODS for streamlining UTS procedures, incorporating a high level of involvement of genetic counselors in tracking and communication of results and in reducing barriers to patient contact, are reviewed within a broader discussion on maximizing the effectiveness and public health impact of UTS.

PMID:
24651603
PMCID:
PMC4169758
DOI:
10.1038/gim.2014.31
[Indexed for MEDLINE]
Free PMC Article

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