Evaluating and improving the implementation of a community-based hereditary cancer screening program
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ORIGINAL ARTICLE
Evaluating and improving the implementation of a community-based hereditary cancer screening program Samantha Greenberg 1,2
&
Beverly M. Yashar 1 & Mark Pearlman 3 & Deb Duquette 4 & Kara Milliron 5 & Monica Marvin 1
Received: 21 April 2017 / Accepted: 5 February 2018 # Springer-Verlag GmbH Germany, part of Springer Nature 2018
Abstract Healthcare disparities exist in the provision of cancer genetic services including genetic counseling and testing related to BRCA1/2 mutations. To address this in a community health setting a screening tool was created to identify high-risk women. This study evaluates the implementation of the tool and identifies opportunities for improved cancer genetic screening, including regular clinician education. A mixed-method approach was used to evaluate clinician utilization of the screening tool at Planned Parenthood affiliates. Novel surveys that evaluated acceptance and implementation were administered to clinicians (n = 14) and semi-structured interviews (n = 6) were used to explore clinicians’ perspectives and identify gaps in its utilization. Educational modules that addressed gaps were developed, implemented, and evaluated using a post-education survey (n = 8). Clinicians reported confidence in administering and interpreting the screening tool, but reported less confidence in their knowledge of cancer genetics and ability to connect clients with genetic counseling and testing (p = .003). Educational modules resulted in significant gains in clinician knowledge on genetic topics (p < .05) and increased self-reported confidence in connecting clients with genetic services. The modules reinforced the belief that genetic testing is beneficial for patients at increased risk (p = .001) and is important to inform subsequent medical management (p = .027). While building community clinicians’ capacity to connect clients with genetic services is crucial, it is challenged by knowledge and confidence gaps in discussions of genetic services with clients. Consistent genetic-focused education with non-genetic clinicians can improve confidence and knowledge, enabling a more effective screening program in community health settings. Keywords BRCA1/2 mutations . Cancergenetic services . Cancer riskevaluation . Access togenetic services . Genetic education . Medically underserved populations
Research conducted at the University of Michigan, Ann Arbor, MI, 48109 * Samantha Greenberg [email protected] 1
Department of Human Genetics, University of Michigan, 4909 Buhl Building, 1241 E Catherine St, Ann Arbor, MI 48109-5618, USA
2
Huntsman Cancer Institute, 2000 Circle of Hope Drive, Salt Lake City, UT 84112, USA
3
University of Michigan Obstetrics and Gynecology, 1540 E Hospital DR SPC 4276, Ann Arbor, MI 48109-4276, USA
4
Feinberg School of Medicine, 645 North Michigan Avenue, Suite 630, Chicago, IL 60611, USA
5
University of Michigan Comprehensive Cancer Center, 300 N Ingalls- 3A12, Ann Arbor, MI 48109-5471, USA
Background Health care disparities have been well documented
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