The development and evaluation of a nationwide training program for oncology health professionals in the provision of genetic testing for ovarian cancer patients

M Gleeson; M Kentwell; B Meiser; J Do; S Nevin; N Taylor; K Barlow-Stewart; J Kirk; P James; C L Scott; R Williams; K Gamet; J Burke; M Murphy; Y C Antill; A Pearn; N Pachter; C Ebzery; N Poplawski; M Friedlander; K M Tucker; Australian Genetic Testing Mainstreaming Collaborative Group

doi:10.1016/j.ygyno.2020.05.001

The development and evaluation of a nationwide training program for oncology health professionals in the provision of genetic testing for ovarian cancer patients

Gynecol Oncol. 2020 Aug;158(2):431-439. doi: 10.1016/j.ygyno.2020.05.001. Epub 2020 May 22.

Authors

M Gleeson¹, M Kentwell², B Meiser³, J Do³, S Nevin³, N Taylor⁴, K Barlow-Stewart⁵, J Kirk⁶, P James⁷, C L Scott⁸, R Williams⁹, K Gamet¹⁰, J Burke¹¹, M Murphy¹², Y C Antill¹³, A Pearn¹⁴, N Pachter¹⁵, C Ebzery¹⁶, N Poplawski¹⁷, M Friedlander¹⁸, K M Tucker⁹; Australian Genetic Testing Mainstreaming Collaborative Group

Affiliations

¹ Hunter Family Cancer Service, Newcastle, Australia. Electronic address: Margaret.gleeson@health.nsw.gov.au.
² Parkville Familial Cancer Clinic, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia; The Royal Women's Hospital, Oncology and Dysplasia, Melbourne, Australia.
³ Prince of Wales Clinical School, UNSW Sydney, Australia.
⁴ The Cancer Council New South Wales, Sydney and Faculty of Health Science, University of Sydney, Australia.
⁵ Sydney Medical School, University of Sydney, Australia.
⁶ Familial Cancer Service, Westmead Hospital, Sydney Medical School, University of Sydney and Centre for Cancer Research, The Westmead Institute for Medical Research, Australia.
⁷ Parkville Familial Cancer Clinic, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia.
⁸ Parkville Familial Cancer Clinic, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia; Department of Obstetrics and Gynaecology and Department of Medical Biology, University of Melbourne, Australia.
⁹ Prince of Wales Clinical School, UNSW Sydney, Australia; Hereditary Cancer Centre, Prince of Wales Hospital, Sydney, Australia.
¹⁰ Genetic Health Service NZ Northern Hub, Auckland City Hospital, Auckland, New Zealand.
¹¹ Tasmanian Clinical Genetics Service, Royal Hobart Hospital, Hobart, Australia.
¹² Parkville Familial Cancer Clinic, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia; Bendigo Health Cancer Centre, Bendigo, Australia.
¹³ Parkville Familial Cancer Clinic, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia; Familial Cancer Centre, Monash Health, Victoria, Australia.
¹⁴ Genetic Services of Western Australia, King Edward Memorial Hospital, Perth, Australia.
¹⁵ Genetic Services of Western Australia, King Edward Memorial Hospital, Perth, Australia; School of Medicine, University of Western Australia, Perth, Australia.
¹⁶ Genetic Health Queensland, Royal Brisbane and Women's Hospital, Queensland, Australia.
¹⁷ Adult Genetics Unit, Royal Adelaide Hospital, Adelaide and School of Medicine, University of Adelaide, Australia.
¹⁸ Dept Medical Oncology, Prince of Wales Hospital, Sydney, Australia.

PMID: 32451123
DOI: 10.1016/j.ygyno.2020.05.001

Abstract

Background: BRCA1/2 mutation status has increasing relevance for ovarian cancer treatments, making traditional coordination of genetic testing by genetic services unsustainable. Consequently alternative models of genetic testing have been developed to improve testing at the initial diagnosis for all eligible women.

Methods: A training module to enable mainstreamed genetic testing by oncology healthcare professionals was developed by genetic health professionals. Oncology healthcare professionals completed questionnaires before and 12 months post-training to assess perceived skills, competence and barriers to their coordinating genetic testing for women with high-grade non-mucinous epithelial ovarian cancer. Genetic health professionals were surveyed 12 months post-training to assess perceived barriers to implementation of mainstreaming.

Results: 185 oncology healthcare professionals were trained in 42 workshops at 35 Australasian hospitals. Of the 273 tests ordered by oncology healthcare professionals post-training, 241 (93.1%) met national testing guidelines. The number of tests ordered by genetic health professionals reduced significantly (z = 45.0, p = 0.008). Oncology healthcare professionals' perceived barriers to mainstreamed testing decreased from baseline to follow-up (t = 2.39, p = 0.023), particularly perceived skills, knowledge and attitudes. However, only 58% reported either 'always' or 'nearly always' having ordered BRCA testing for eligible patients at 12 months, suggesting oncology healthcare professionals' perceived barriers were not systematically addressed through training.

Conclusions: Oncology healthcare professionals have demonstrated a willingness to be involved in the provision of genetic testing in a mainstreaming model. If oncology services are to hold responsibility for coordinating genetic testing, their readiness will require understanding of barriers not addressed by training alone to inform future intervention design.

Keywords: BRCA1/BRCA2; Genetic testing; Mainstreaming; Ovarian cancer.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
BRCA1 Protein / genetics
BRCA2 Protein / genetics
Carcinoma, Ovarian Epithelial / genetics*
Education, Medical, Continuing
Female
Genetic Testing / methods*
Genetics / education*
Health Personnel / education
Humans
Male
Medical Oncology / education*
Middle Aged
Ovarian Neoplasms / genetics*
Young Adult

Substances

BRCA1 Protein
BRCA1 protein, human
BRCA2 Protein
BRCA2 protein, human