Search Results

You are looking at 1 - 3 of 3 items for

  • Author: Brandie Heald x
  • Refine by Access: All x
Clear All Modify Search
Full access

Time Studies of the Tasks Associated with Comprehensive Cancer Genetics Counseling

Brandie Heald and Charis Eng

Full access

A Time Study of Cancer Genetic Counselors Using a Genetic Counselor-Only Patient Care Model Versus a Traditional Combined Genetic Counselor Plus Medical Geneticist Care Model

Brandie Heald, Shanna Gustafson, Jessica Mester, Patricia Arscott, Katherine Lynch, Jessica Moline, and Charis Eng

Analyses of time-based effort have determined that clinical genetic services are labor-intensive, although these data derive primarily from studying geneticists’ efforts in the pediatric model. No studies have investigated the time and patient care activities of cancer genetic counselors (GCs) in traditional clinics with a medical geneticist (GC/MD) compared with genetic counselor-only (GCO) appointments. In this study, 6 GCs prospectively tracked time spent in patient care activities in both clinical settings. The authors found that overall, GCs’ time spent per patient was lower for GCO versus GC/MD visits. No differences were seen in time spent on results disclosure, but differences were noted in case preparation, face-to-face, and follow-up times. Furthermore, no differences were seen in number of case preparation activities or topics covered during a session. These data suggest that GCO visits result in better use of GCs’ time, without a trade-off in number of patient-related activities.

Full access

Referral, Uptake, and Outcome of Genetic Counseling and Testing in Patients With Early-Onset Colorectal Cancer

Hareem Syed, Joshua Sommovilla, Carol A. Burke, Sarah McGee, Carole Macaron, Brandie Heald, Ruishen Lyu, Stephanie L. Schmit, Kanika Nair, Suneel Kamath, Smitha Krishnamurthi, Alok A. Khorana, and David Liska

Background: The incidence of early-onset colorectal cancer (EOCRC) is rapidly increasing. Pathogenic germline variants (PGVs) are detected in 16% to 20% of patients who have EOCRC, highlighting a need for genetic counseling (GC) and multigene panel testing in these patients. We aimed to determine the rate of referral to GC and uptake and outcomes of germline testing in patients with EOCRC. Methods: We conducted a retrospective cohort study of patients aged <50 years diagnosed with colorectal cancer (CRC) from 2010 to 2019 at Cleveland Clinic. Demographic data were extracted, including age, sex, self-reported race, and family history of CRC. The proportions of patients with GC referral and completion of GC and genetic testing were investigated, and genetic testing results were analyzed. Multivariable logistic regression analysis was conducted to identify factors independently associated with GC referral and uptake. Results: A total of 791 patients with EOCRC (57% male and 43% female) were included; 62% were referred for GC, and of those who were referred, 79% completed a GC appointment and 77% underwent genetic testing. Of those who underwent testing, 21% had a PGV detected; 82% were in known CRC-associated genes, with those associated with Lynch syndrome and familial adenomatous polyposis the most common, and 11% were in other actionable genes. Referral to GC was positively associated with family history of CRC (odds ratio [OR], 2.11; 95% CI, 1.51–2.96) and more recent year of diagnosis (2010–2013 vs 2017–2019; OR, 5.36; 95% CI, 3.59–8.01) but negatively associated with older age at diagnosis (OR, 0.89; 95% CI, 0.86–0.92). Conclusions: Referral to GC for patients with EOCRC is increasing over time; however, even in recent years, almost 25% of patients were not referred for GC. We found that 1 in 5 patients with EOCRC carry actionable PGVs, highlighting the need for health systems to implement care pathways to optimize GC referral and testing in all patients with EOCRC.