Congress Abstracts 2004

17

DEVELOPING A HEREDITARY CANCER GENETICS CONSULTATION SERVICE UTILIZING ADVANCED PRACTICE NURSES. Karen Roesser, RN, MS, AOCN^®, and Tracey Tatum, RN, MS, ANP, CJW Medical Center, Richmond, VA.

As increased knowledge has emerged in the field of cancer genetics, so has awareness among healthcare professionals, as well as the public. Advanced practice nurses (APNs) are in a prime position of providing cancer predisposition genetic testing and risk assessment counseling. In 2002, the ONS position statement on “Cancer Predisposition Genetic Testing and Risk Assessment Counseling” stated that APNs with specialized training in cancer genetics might provide comprehensive cancer genetic counseling.

In striving to meet the needs of our patients with possible hereditary cancer (based on family history), we began a nurse managed hereditary cancer genetics consultation service. Patients, as well as physicians, had articulated that they wished to have this service available at our institution rather than undergo referrals to an outside hospital. In addition, physicians recognized that as patients were beginning to inquire more about their risks, they did not have the time or expertise to answer these questions or counsel patients adequately regarding hereditary cancers.

In order to be able to provide this service, the oncology clinical nurse specialist attended genetic training through Fox Chase Cancer Center and also with Myriad Genetic Labs. Referrals for genetic consultation were received through physicians. If a patient called independently, they were asked to obtain a referral by their physician before they would be assessed. As there were no physicians on site who were able to provide expertise in this area, the oncology clinical nurse specialist utilized counselors at Myriad Genetic Labs to discuss complex family histories or results needing further clarification. On the initial visit, the APN met with patients to discuss their history and to develop pedigrees. Education was provided regarding hereditary cancer risk. If the patient wished to pursue genetic counseling, they would return for a second visit. Insurance reimbursement was always pursued prior to the second visit. Informed consent was obtained prior to testing. A third visit was arranged after test results became available. In addition, scheduling a fourth visit was an option to meet with additional family members per patient request.

To date, no patient has requested to receive this service outside of our hospital. In addition, as interest has increased in this area, so have referrals. Since 2000, there has been a ten-fold increase in referrals for genetic consultation at our institution. Because of this increase in referrals, a second APN has been educated in cancer genetics to assume some of this caseload. Because this APN held the role of breast cancer coordinator, she, therefore, assesses those patients at risk for breast/ovarian cancers. The second APN assesses those patients at risk for colon/endometrial cancers.

With the identification of cancer susceptibility genes, a new field of oncology has opened up with APNs in a role to become leaders. Because APNs are already clinical experts in oncology, additional education in this field of hereditary cancer genetics can prepare them to take on this additional role. This could become a service provided by all comprehensive community cancer centers that utilize APNs.