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• W4295234883 abstract "Objectives: Underrepresented minority (URM) women meeting National Comprehensive Cancer Network (NCCN) criteria for hereditary cancer testing are less likely to be referred for genetic counseling and more likely to encounter barriers to genetic testing. Language barriers, transportation challenges, lack of insurance coverage, and provider bias disproportionately affect this population. A national shortage of certified genetic counselors (CGC), particularly in low- resource areas, heightens this disparity. We sought to study the impact of a universal risk assessment and testing program, meticulously supported by a community health worker (CHW), through routine women’s health visits at a large safety-net hospital serving >70% URM patients. Methods: This pilot program was initiated in women’s health clinics by administering original NCCN-based questionnaires in English and Spanish. Patients meeting high-risk criteria were offered videobased genetic pre-test counseling. Risk assessment and testing were facilitated by a CHW who worked alongside a CGC and a gynecologic oncologist. Patients were notified of results by a physician and were offered post-test counseling with a CGC via telehealth. The primary measure of success was defined as the number of genetic tests performed during the first 18 months of our program compared to the preceding 18 months, in which screening, counseling, and testing were performed solely by routine clinical practice and a single CGC. We also evaluated the extent to which CHW involvement was needed to achieve successful genetic screening, counseling, and testing. Results: Between January 2020 and June 2021, 1516 patients completed the questionnaires, of which 50% were in Spanish. Of these, 1116 screened completely negative for any relevant history, and 400 (26%) had positive history requiring further investigation. Over 90% with some pertinent history required CHW assistance to adequately complete the questionnaires. After further review, 234 (16%) met the criteria for hereditary cancer testing, and 150 underwent videobased pre-test counseling. To date, 138 patients consented to genetic testing and had their panel testing ordered, and 88 have been completed. Compared to the preceding 18 months, there had been a 140% increase in tests completed through women’s health clinics at our institution. Of the 88 patients tested, ten (11%) carried pathogenic variants in hereditary cancer genes, and seven of 10 identified as Hispanic. All ten had received post-test counseling by a CGC. Conclusions: This pilot program demonstrates the feasibility of a CHW-guided program, using self-administered hereditary cancer risk questionnaires and telehealth-based testing, in a primarily URM population. CHW support was essential for most patients to be adequately screened, counseled, and tested. Implemented on a larger scale, programs of this type may improve access and overcome barriers to hereditary cancer testing in an underscreened and undertested population. Objectives: Underrepresented minority (URM) women meeting National Comprehensive Cancer Network (NCCN) criteria for hereditary cancer testing are less likely to be referred for genetic counseling and more likely to encounter barriers to genetic testing. Language barriers, transportation challenges, lack of insurance coverage, and provider bias disproportionately affect this population. A national shortage of certified genetic counselors (CGC), particularly in low- resource areas, heightens this disparity. We sought to study the impact of a universal risk assessment and testing program, meticulously supported by a community health worker (CHW), through routine women’s health visits at a large safety-net hospital serving >70% URM patients. Methods: This pilot program was initiated in women’s health clinics by administering original NCCN-based questionnaires in English and Spanish. Patients meeting high-risk criteria were offered videobased genetic pre-test counseling. Risk assessment and testing were facilitated by a CHW who worked alongside a CGC and a gynecologic oncologist. Patients were notified of results by a physician and were offered post-test counseling with a CGC via telehealth. The primary measure of success was defined as the number of genetic tests performed during the first 18 months of our program compared to the preceding 18 months, in which screening, counseling, and testing were performed solely by routine clinical practice and a single CGC. We also evaluated the extent to which CHW involvement was needed to achieve successful genetic screening, counseling, and testing. Results: Between January 2020 and June 2021, 1516 patients completed the questionnaires, of which 50% were in Spanish. Of these, 1116 screened completely negative for any relevant history, and 400 (26%) had positive history requiring further investigation. Over 90% with some pertinent history required CHW assistance to adequately complete the questionnaires. After further review, 234 (16%) met the criteria for hereditary cancer testing, and 150 underwent videobased pre-test counseling. To date, 138 patients consented to genetic testing and had their panel testing ordered, and 88 have been completed. Compared to the preceding 18 months, there had been a 140% increase in tests completed through women’s health clinics at our institution. Of the 88 patients tested, ten (11%) carried pathogenic variants in hereditary cancer genes, and seven of 10 identified as Hispanic. All ten had received post-test counseling by a CGC. Conclusions: This pilot program demonstrates the feasibility of a CHW-guided program, using self-administered hereditary cancer risk questionnaires and telehealth-based testing, in a primarily URM population. CHW support was essential for most patients to be adequately screened, counseled, and tested. Implemented on a larger scale, programs of this type may improve access and overcome barriers to hereditary cancer testing in an underscreened and undertested population." @default.
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• W4295234883 date "2022-08-01" @default.
• W4295234883 modified "2023-09-27" @default.
• W4295234883 title "Community health worker supported hereditary cancer risk assessment in a large safety net hospital (429)" @default.
• W4295234883 doi "https://doi.org/10.1016/s0090-8258(22)01651-1" @default.
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