Interventions to improve delivery of cancer genetics services in the United States: A scoping review

Abstract

Purpose: Interventions that decrease barriers and improve clinical processes can increase patient access to guideline-recommended cancer genetics services. We sought to identify and describe interventions to improve patient receipt of guideline-recommended cancer genetics services in the United States.

Methods: We performed a comprehensive search in Ovid MEDLINE and Embase, Scopus, and Web of Science from January 1, 2000 to February 12, 2020. Eligible articles reported interventions to improve the identification, referral, genetic counseling (GC), and genetic testing (GT) of patients in the United States. We independently screened titles and abstracts and reviewed full-text articles. Data were synthesized by grouping articles by clinical process.

Results: Of 44 included articles, 17 targeted identification of eligible patients, 14 targeted referral, 15 targeted GC, and 16 targeted GT. Patient identification interventions included universal tumor testing and screening of medical/family history. Referral interventions included medical record system adaptations, standardizing processes, and provider notifications. GC interventions included supplemental patient education, integrated GC within oncology clinics, appointment coordination, and alternative service delivery models. One article directly targeted the GT process by implementing provider-coordinated testing.

Conclusion: This scoping review identified and described interventions to improve US patients' access to and receipt of guideline-recommended cancer genetics services.

Keywords: Cancer genetics; Genetic counseling; Genetic testing; Interventions; Scoping review.

Figure 1

Study inclusion and exclusion.

Figure 2. Process and factors impacting delivery of genetics services.

White circles, policy factors; Gray circles, clinic factors/decisions; Black circles, Patient factors/decisions. GC, genetic counseling; HCP, health care provider.