Top

Published in:

01-12-2014 | Original Research

An Internal Performance Assessment of CancerGene Connect: An Electronic Tool to Streamline, Measure and Improve the Genetic Counseling Process

Authors: Mary Pritzlaff, Arielle Yorczyk, Linda S. Robinson, Sara Pirzadeh-Miller, Tirun Lin, David Euhus, Theodora S Ross

Published in: Journal of Genetic Counseling | Issue 6/2014

Abstract

CancerGene Connect (CGC) is a web-based program that combines the collection of family and medical history, cancer risk assessment, psychosocial assessment, report templates, a result tracking system, and a patient follow up system. The performance of CGC was assessed in several ways: pre-appointment completion data analyzed for demographic and health variables; a time study to assess overall time per case and to compare the data entry by the genetic counselor compared to the patient, and a measured quality assessment of the program via observation and interview of patients. Prior to their appointment, 52.3 % of 2,414 patients completed the online patient questionnaire section of CGC. There were significant differences in completion rates among racial and ethnic groups. County hospital patients were less likely to complete the questionnaire than insured patients (p < 0.0001); and likewise uninsured patients and patients with Medicare/Medicaid were less likely to complete the questionnaire than private patients (p < 0.0001). The average genetic counseling time per case was 82 min, with no significant differences whether the counselor or the patient completed CGC. CGC reduces genetic counselor time by approximately 14–46 % compared to average time per case using traditional risk assessment and documentation methods previously reported. All surveyed users felt the questionnaire was easy to understand. CGC is an effective tool that streamlines workflow, and provides a standardized data collection tool that can be used to evaluate and improve the genetic counseling process.

Acheson, L. S., Zyzanski, S. J., Stange, K. C., Deptowicz, A., & Wiesner, G. L. (2006). Validation of a self-administered, computerized tool for collecting and displaying the family history of cancer. Journal of Clinical Oncology, 24(34), 5395–5402. doi:10.1200/jco.2006.07.2462.PubMedCrossRef

Ali, J., Barrow, L., & Vuylsteke, A. (2010). The impact of computerised physician order entry on prescribing practices in a cardiothoracic intensive care unit. Anaesthesia, 65(2), 119–123. doi:10.1111/j.1365-2044.2009.06134.x.PubMedCrossRef

Appleby-Tagoe, J. H., Foulkes, W. D., & Palma, L. (2012). Reading between the lines: a comparison of responders and non-responders to a family history questionnaire and implications for cancer genetic counselling. Journal of Genetic Counseling, 21(2), 273–291. doi:10.1007/s10897-011-9399-0.PubMedCrossRef

Bond, M. C., Klemt, R., Merlis, J., Kopinski, J. E., & Hirshon, J. M. (2012). Computer access and Internet use by urban and suburban emergency department customers. Journal of Emergency Medicine, 43(1), 159–165. doi:10.1016/j.jemermed.2011.03.034.PubMedCrossRef

Chaudhry, B., Wang, J., Wu, S., Maglione, M., Mojica, W., Roth, E., et al. (2006). Systematic review: impact of health information technology on quality, efficiency, and costs of medical care. Annals of Internal Medicine, 144(10), 742–752.PubMedCrossRef

Chen, S., Wang, W., Lee, S., et al. (2006). PRediction of germline mutations and cancer risk in the lynch syndrome. JAMA, 296(12), 1479–1487. doi:10.1001/jama.296.12.1479.PubMedCentralPubMedCrossRef

Cohen, S., & Hoberman, H. M. (1983). Positive events and social supports as buffers of life change Stress1. Journal of Applied Social Psychology, 13(2), 99–125.CrossRef

Cohen, S. A., & McIlvried, D. E. (2011). Impact of computer-assisted data collection, evaluation and management on the cancer genetic counselor’s time providing patient care. Familial Cancer, 10(2), 381–389. doi:10.1007/s10689-011-9417-2.PubMedCrossRef

Commission on Cancer (COC). (2012). Cancer Program Standards 2012: Ensuing Patient-Centered Care. (1), 140. http://www.facs.org/cancer/coc/programstandards2012.pdf.

Dominguez, F. J., Lawrence, C., Halpern, E. F., Drohan, B., Grinstein, G., Black, D. M., et al. (2007). Accuracy of self-reported personal history of cancer in an outpatient breast center. Journal of Genetic Counseling, 16(3), 341–345. doi:10.1007/s10897-006-9067-y.PubMedCrossRef

Euhus, D. M. (2001). Understanding mathematical models for breast cancer risk assessment and counseling. Breast Journal, 7(4), 224–232.PubMedCrossRef

Gaff, C. L., Aragona, C., MacInnis, R. J., Cowan, R., Payne, C., Giles, G. G., et al. (2004). Accuracy and completeness in reporting family history of prostate cancer by unaffected men. Urology, 63(6), 1111–1116. doi:10.1016/j.urology.2003.12.032.PubMedCrossRef

Glanz, K., Grove, J., Le Marchand, L., & Gotay, C. (1999). Underreporting of family history of colon cancer: correlates and implications. Cancer Epidemiology, Biomarkers and Prevention, 8(7), 635–639.PubMed

Greene, F.L. (2013). Cancer Program Standards 2012: Ensuring Patient-Centered Care, Version 1/2. Commission on Cancer. Retrieved from Cancer Program Standards 2012: Ensuring Patient-Centered Care, Version 1.2 website: http://www.facs.org/cancer/coc/programstandards2012.pdf.

Hilton, J. F., Barkoff, L., Chang, O., Halperin, L., Ratanawongsa, N., Sarkar, U., et al. (2012). A cross-sectional study of barriers to personal health record use among patients attending a safety-net clinic. PLoS ONE, 7(2), e31888. doi:10.1371/journal.pone.0031888.PubMedCentralPubMedCrossRef

Horowitz, M., Wilner, N., & Alvarez, W. (1979). Impact of event scale: a measure of subjective stress. Psychosomatic Medicine, 41(3), 209–218.PubMedCrossRef

Hurtado, M. P., Angeles, J., Blahut, S. A., & Hays, R. D. (2005). Assessment of the equivalence of the Spanish and English versions of the CAHPS Hospital Survey on the quality of inpatient care. Health Services Research, 40, 2140–2161.PubMedCentralPubMedCrossRef

Jani, Y. H., Ghaleb, M. A., Marks, S. D., Cope, J., Barber, N., & Wong, I. C. (2008). Electronic prescribing reduced prescribing errors in a pediatric renal outpatient clinic. Journal of Pediatrics, 152(2), 214–218. doi:10.1016/j.jpeds.2007.09.046.PubMedCrossRef

Kadan-Lottick, N. S., Friedman, D. L., Mertens, A. C., Whitton, J. A., Yasui, Y., Strong, L. C., et al. (2003). Self-reported family history of cancer: the utility of probing questions. Epidemiology, 14(6), 737–740. doi:10.1097/01.ede.0000091602.06231.aa.PubMedCrossRef

King, T. M., Tong, L., Pack, R. J., Spencer, C., & Amos, C. I. (2002). Accuracy of family history of cancer as reported by men with prostate cancer. Urology, 59(4), 546–550.PubMedCrossRef

Lepanto, L., Pare, G., & Gauvin, A. (2006). Impact of PACS deployment strategy on dictation turnaround time of chest radiographs. Academic Radiology, 13(4), 447–452. doi:10.1016/j.acra.2005.12.008.PubMedCrossRef

Lu, K. H., Wood, M. E., Daniels, M., Burke, C., Ford, J., Kauff, N. D., et al. (2014). American society of clinical oncology expert statement: collection and use of a cancer family history for oncology providers). Journal of Clinical Oncology, 32(8), 833–840.PubMedCrossRef

Mai, P. L., Garceau, A. O., Graubard, B. I., Dunn, M., McNeel, T. S., Gonsalves, L., et al. (2011). Confirmation of family cancer history reported in a population-based survey. Journal of the National Cancer Institute, 103(10), 788–797. doi:10.1093/jnci/djr114.PubMedCentralPubMedCrossRef

McPherson, E., Zaleski, C., Benishek, K., McCarty, C. A., Giampietro, P. F., Reynolds, K., et al. (2008). Clinical genetics provider real-time workflow study. Genetics in Medicine, 10(9), 699–706.PubMedCrossRef

Murff, H. J., Spigel, D. R., & Syngal, S. (2004). Does this patient have a family history of cancer? An evidence-based analysis of the accuracy of family cancer history. JAMA, 292(12), 1480–1489. doi:10.1001/jama.292.12.1480.PubMedCrossRef

National Accreditation Program for Breast Centers (NAPBC). (2012). 2012 Breast Cancer Standards Manual. (1), 72. http://napbc-breast.org/standards/2012standardsmanual.pdf.

Ozanne, E. M., O’Connell, A., Bouzan, C., Bosinoff, P., Rourke, T., Dowd, D., et al. (2012). Bias in the reporting of family history: implications for clinical care. Journal of Genetic Counseling, 21(4), 547–556. doi:10.1007/s10897-011-9470-x.PubMedCrossRef

Parent, M. E., Ghadirian, P., Lacroix, A., & Perret, C. (1997). The reliability of recollections of family history: implications for the medical provider. Journal of Cancer Education, 12(2), 114–120. doi:10.1080/08858199709528465.PubMed

Pinsky, P. F., Kramer, B. S., Reding, D., & Buys, S. (2003). Reported family history of cancer in the prostate, lung, colorectal, and ovarian cancer screening trial. American Journal of Epidemiology, 157(9), 792–799.PubMedCrossRef

Quillin, J. M., Ramakrishnan, V., Borzelleca, J., Bodurtha, J., Bowen, D., & Baer Wilson, D. (2006). Paternal relatives and family history of breast cancer. American Journal of Preventive Medicine, 31(3), 265–268. doi:10.1016/j.amepre.2006.05.002.PubMedCrossRef

Radloff, L. S. (1977). The CES-D scale a self-report depression scale for research in the general population. Applied Psychological Measurement, 1(3), 385–401.CrossRef

Shamliyan, T. A., Duval, S., Du, J., & Kane, R. L. (2008). Just what the doctor ordered. Review of the evidence of the impact of computerized physician order entry system on medication errors. Health Services Research, 43(1 Pt 1), 32–53. doi:10.1111/j.1475-6773.2007.00751.x.PubMedCentralPubMed

Simon, C., Acheson, L., Burant, C., Gerson, N., Schramm, S., Lewis, S., et al. (2008). Patient interest in recording family histories of cancer via the Internet. Genetics in Medicine, 10(12), 895–902. doi:10.1097/GIM.0b013e31818de708.PubMedCentralPubMedCrossRef

Smith, M., Dang, D., & Lee, J. (2009). E-prescribing: clinical implications for patients with diabetes. Journal of Diabetes Science and Technology, 3(5), 1215–1218.PubMedCentralPubMedCrossRef

Uhlmann, W. R., Schuette, J. L., & Yashar, B. (2011). A guide to genetic counseling: Wiley. com.

Weidmar, B., Brown, J., & Garcia, L. (1999). Translating the CAHPS 1.0 survey instrument into spanish. Medical Care, 37(3 Suppl), MS89–MS96.

Weinrich, S. P., Faison-Smith, L., Hudson-Priest, J., Royal, C., & Powell, I. (2002). Stability of self-reported family history of prostate cancer among African American men. Journal of Nursing Measurement, 10(1), 39–46.PubMedCrossRef

Westman, J., Hampel, H., & Bradley, T. (2000). Efficacy of a touchscreen computer based family cancer history questionnaire and subsequent cancer risk assessment. Journal of Medical Genetics, 37(5), 354–360.PubMedCentralPubMedCrossRef

Wham, D., Vu, T., Chan-Smutko, G., Kobelka, C., Urbauer, D., & Heald, B. (2010). Assessment of clinical practices among cancer genetic counselors. Familial Cancer, 9(3), 459–468. doi:10.1007/s10689-010-9326-9.PubMedCrossRef

Wideroff, L., Garceau, A. O., Greene, M. H., Dunn, M., McNeel, T., Mai, P., et al. (2010). Coherence and completeness of population-based family cancer reports. Cancer Epidemiology, Biomarkers and Prevention, 19(3), 799–810. doi:10.1158/1055-9965.epi-09-1138.PubMedCentralPubMedCrossRef

Widmer, C., Deshazo, J. P., Bodurtha, J., Quillin, J., & Creswick, H. (2013). Genetic counselors’ current use of personal health records-based family histories in genetic clinics and considerations for their future adoption. Journal of Genetic Counseling, 22(3), 384–392. doi:10.1007/s10897-012-9557-z.PubMedCrossRef

Willis, G. B. (2004). Cognitive interviewing: A tool for improving questionnaire design. Thousand Oaks: Sage Publications.

Ziogas, A., & Anton-Culver, H. (2003). Validation of family history data in cancer family registries. American Journal of Preventive Medicine, 24(2), 190–198.PubMedCrossRef

Title: An Internal Performance Assessment of CancerGene Connect: An Electronic Tool to Streamline, Measure and Improve the Genetic Counseling Process
Authors: Mary Pritzlaff
Arielle Yorczyk
Linda S. Robinson
Sara Pirzadeh-Miller
Tirun Lin
David Euhus
Theodora S Ross
Publication date: 01-12-2014
Publisher: Springer US
Published in: Journal of Genetic Counseling / Issue 6/2014
Print ISSN: 1059-7700
Electronic ISSN: 1573-3599
DOI: https://doi.org/10.1007/s10897-014-9732-5

At a glance: The STEP trials

Springer Medicine

An Internal Performance Assessment of CancerGene Connect: An Electronic Tool to Streamline, Measure and Improve the Genetic Counseling Process

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 6/2014

Client Views and Attitudes to Non-Invasive Prenatal Diagnosis for Sickle Cell Disease, Thalassaemia and Cystic Fibrosis

The Impact of Supervision Training on Genetic Counselor Supervisory Identity Development

Cost Sharing and Hereditary Cancer Risk: Predictors of Willingness-to-Pay for Genetic Testing

An Exploration of Genetic Counselors’ Needs and Experiences with Prenatal Chromosomal Microarray Testing

Presented Abstracts from the Thirty Third Annual Education Conference of the National Society of Genetic Counselors (New Orleans, LA, September 2014)

Disclosure of Genetic Research Results to Members of a Founder Population