Disseminating universal genetic testing to a diverse, indigent patient population at a county hospital gynecologic oncology clinic.
OBJECTIVE
The universal genetic testing initiative (UGTI) is a quality improvement effort to increase rates of guideline-based genetic counseling (GC) and genetic testing (GT) of patients with potentially hereditary cancers. The UGTI was disseminated to a county hospital gynecologic oncology clinic that serves a diverse, indigent patient population.


METHODS
Using the Model for Improvement quality improvement framework, interventions including integrated GC, clinic tracking, assisted GC referrals, and provider education were tested over 26 months. A retrospective data review included patients with high-grade, non-mucinous epithelial ovarian, fallopian tube, and primary peritoneal cancers (HGOC) and endometrial cancers (EC) diagnosed between 9/1/12-8/31/16. Statistical analyses were performed to describe the population and to evaluate rates of recommendation and use of immunohistochemistry tumor testing (IHC), GC, and GT.


RESULTS
A cohort of 241 patients (57 HGOC, 184 EC) were included. At the conclusion of the study 84.2% of HGOC patients were referred for GC, 89.6% (43/48) completed GC, and 90.7% (39/43) completed GT. Of EC patients, 81.0% were recommended to have IHC and 62.4% (93/149) completed IHC. Patients with HGOC diagnosed during dissemination of UGTI were significantly more likely to receive a recommendation for GC (p = 0.02) and to complete GT (p = 0.03) than those diagnosed before UGTI. Patients with EC were significantly more likely to complete IHC if diagnosed after UGTI than those diagnosed prior to dissemination (p < 0.001).


CONCLUSIONS
The UGTI can be adapted to increase use of guideline-based cancer genetics services in a diverse, indigent, gynecologic cancer patient population.
['Bednar|Erica M|EM|', 'Sun|Charlotte C|CC|', 'Camacho|Bethsaida|B|', 'Terrell|John|J|', 'Rieber|Alyssa G|AG|', 'Ramondetta|Lois M|LM|', 'Freedman|Ralph S|RS|', 'Lu|Karen H|KH|']
D000328:Adult D000368:Aged D000077216:Carcinoma, Ovarian Epithelial D015331:Cohort Studies D005185:Fallopian Tube Neoplasms D005260:Female D005817:Genetic Counseling D005820:Genetic Testing D005833:Genital Neoplasms, Female D006766:Hospitals, County D006801:Humans D008875:Middle Aged D010534:Peritoneal Neoplasms D011203:Poverty D012189:Retrospective Studies D055815:Young Adult
Genetic testing Quality improvement Genetic counseling Endometrial cancer Ovarian cancer