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Cancers (Basel). 2018 Nov 13;10(11). pii: E435. doi: 10.3390/cancers10110435.

Next-Generation Service Delivery: A Scoping Review of Patient Outcomes Associated with Alternative Models of Genetic Counseling and Genetic Testing for Hereditary Cancer.

McCuaig JM1,2,3, Armel SR4,5, Care M6,7,8, Volenik A9,10, Kim RH11,12, Metcalfe KA13,14.

Author information

1
Familial Cancer Clinic, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2M9, Canada. Jeanna.mccuaig@uhn.ca.
2
Department of Molecular Genetics, University of Toronto, Toronto, ON M5S 1A8, Canada. Jeanna.mccuaig@uhn.ca.
3
Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON M5T 1P8, Canada. Jeanna.mccuaig@uhn.ca.
4
Familial Cancer Clinic, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2M9, Canada. susan.randall@uhn.ca.
5
Department of Molecular Genetics, University of Toronto, Toronto, ON M5S 1A8, Canada. susan.randall@uhn.ca.
6
Department of Molecular Genetics, University of Toronto, Toronto, ON M5S 1A8, Canada. melanie.care@uhn.ca.
7
Division of Cardiology, Department of Medicine, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, ONM5G 2C4, Canada. melanie.care@uhn.ca.
8
Genome Diagnostics, Toronto General Hospital, University Health Network, Toronto, ON M5G 2C4, Canada. melanie.care@uhn.ca.
9
Familial Cancer Clinic, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2M9, Canada. alexandra.volenik@uhn.ca.
10
Department of Molecular Genetics, University of Toronto, Toronto, ON M5S 1A8, Canada. alexandra.volenik@uhn.ca.
11
Familial Cancer Clinic, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2M9, Canada. raymond.kim@uhn.ca.
12
Department of Medicine, Division of Medical Oncology and Hematology, University of Toronto, Toronto, ON M5S 1A8, Canada. raymond.kim@uhn.ca.
13
Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON M5T 1P8, Canada. kelly.metcalfe@utoronto.ca.
14
Women's College Research Institute, Women's College Hospital, Toronto, ON M5G 1N8, Canada. kelly.metcalfe@utoronto.ca.

Abstract

The combination of increased referral for genetic testing and the current shortage of genetic counselors has necessitated the development and implementation of alternative models of genetic counseling and testing for hereditary cancer assessment. The purpose of this scoping review is to provide an overview of the patient outcomes that are associated with alternative models of genetic testing and genetic counseling for hereditary cancer, including germline-only and tumor testing models. Seven databases were searched, selecting studies that were: (1) full-text articles published ≥2007 or conference abstracts published ≥2015, and (2) assessing patient outcomes of an alternative model of genetic counseling or testing. A total of 79 publications were included for review and synthesis. Data-charting was completed using a data-charting form that was developed by the study team for this review. Seven alternative models were identified, including four models that involved a genetic counselor: telephone, telegenic, group, and embedded genetic counseling models; and three models that did not: mainstreaming, direct, and tumor-first genetic testing models. Overall, these models may be an acceptable alternative to traditional models on knowledge, patient satisfaction, psychosocial measures, and the uptake of genetic testing; however, particular populations may be better served by traditional in-person genetic counseling. As precision medicine initiatives continue to advance, institutions should consider the implementation of new models of genetic service delivery, utilizing a model that will best serve the needs of their unique patient populations.

KEYWORDS:

BRCA; genetic counseling; genetic service delivery; genetic testing; hereditary cancer; patient outcomes

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