3 Ways to Take Your Risk Assessment Program From Good to Great

Paper questionnaires for determining a patient's risk for hereditary cancers. Limited genetic counselor resources throughout the country. Too much burdensome administrative work. These are common problems that cancer risk assessment programs across the country are facing.

But how are healthcare providers overcoming these challenges? This was the topic of a recent three-part webinar series in which three providers shared how they overcame these challenges and transformed their programs. Here is the wrap-up and key takeaways from each session.

How to Better Identify High-Risk Patients Using a Risk Assessment Tool

According to national guidelines, approximately 2.7 million people in the U.S. are estimated to be at elevated risk for hereditary breast and ovarian cancer. However, due to challenges in the screening process, most patients who are at risk go unidentified. One common challenge is the use of a paper family history questionnaire to identify at-risk patients.

This was the focus of the webinar “Moving From Paper to Software to Better Identify High-Risk Patients.”

Using paper forms to flag patients who are at increased or high risk for hereditary cancer may be easy to implement, but with it comes several challenges, said Julie Sieling, MSN, APN, NP-C, CN-BP, a genetics-trained advanced practice nurse at the Riverside Healthcare Breast Center, during the live virtual event. Three of those key challenges are that paper family history forms:

1. Require humans to evaluate results according to a complex, ever-changing set of guidelines.
2. Need frequent updates (as well as retraining) to stay up to date with the most recent guidelines.
3. Have lower patient accuracy in reporting information due to “multi-segment” questions.

To overcome these barriers, the Riverside Healthcare Breast Center migrated from the manual paper forms to a digital risk assessment tool that automatically flags patients who are eligible for genetic counseling and testing. And in doing so, the breast center transformed their program and nearly doubled the number of high-risk patients identified for MRI surveillance.

“Technology helped us overcome barriers to identifying women at increased risk for cancer by simplifying the screening process, providing immediate determination of patient risk, and reducing stress levels for both our patients and our mammography technicians,” said Sieling in a recent Health Data Management article.

If your program currently uses a paper process for flagging high-risk patients, you can benefit from using a cancer risk assessment software that automates the process. Perhaps your current process is cumbersome. Or maybe your staff, like mammography technicians, are stressed out from determining a patient's risk manually, or they may need to constantly check the latest updates to the guidelines (which is one of three signs you may need a cancer risk assessment software).

Watch the recorded webinar to learn how you can transform your hereditary cancer risk assessment program moving from paper to software.

How A Genetics-Trained Nurse Practitioner Can Help Scale Genetic Counseling Services

In some settings like rural Illinois, the referral to a genetic counselor has created barriers for patients, which can negatively impact both patient experience and outcomes. This is where alternative solutions like hiring a genetics-trained nurse practitioner can help your program.

This was the topic of the webinar "Scaling Cancer Genetic Services Through Nursing Innovation," presented by Michele Settelmyer, APN, MSN, WHNP-BC, from OSF HealthCare.

During the virtual event, Settelmyer laid out three ways hereditary cancer risk assessment programs can scale their services:

• Consider an advanced practice nurse (APN) to fill the gap. Nurse practitioners already manage patients who have chronic diseases. With additional training in genetics from programs like City of Hope, the nurse practitioner can fill the role of genetic specialist for more traditional hereditary breast and ovarian cancers and Lynch Syndrome - making genetic services more accessible to their patients.

"Nurses could be that role as the genetic specialist to determine if their patients are at high-risk for hereditary cancer. If they or their family are at high-risk for a genetic cancer, nurses can recommend genetic testing," said Settelmyer in an interview with Oncology Nursing News. 

• Consider software to manage high-risk patients over time. Managing patient care includes helping to develop and implement a treatment plan. Software that helps to coordinate care and monitoring patient adherence can help overcome barriers and improve outcomes. As well, you could track the number of patients identified as needing additional genetic testing, how many of those patients receive a referral for genetic counseling, and how many of those referrals actually meet the genetic specialist. This would help you identify where patients may be falling through the cracks. (When evaluating software, don't forget these five practical steps.)
• Ensure patients get from point A to point B. Once a patient is flagged as being at increased or high risk, referring them elsewhere for genetics-expertise may create a barrier to counseling and testing. Factor in having to schedule an appointment with the genetics specialist at a later point in time, and the barriers increase. Instead, you may consider a workflow in which patients schedule their appointment with a genetics-trained nurse practitioner prior to leaving.

Watch the recorded webinar to learn how your program you can leverage a nurse practitioner to scale your genetic counseling services.

How to Streamline Your Genetic Counseling Appointments

According to the National Society of Genetic Counselors, the average initial genetic counseling appointment takes up to two hours. This may include gathering the patient's family history, drawing a pedigree from scratch, and completing prior authorization insurance forms. However, this manual work can result in a backlog of patients who would benefit from genetic services.

So how can a specialist streamline their genetic counseling appointments?

This was one of several key points touched on in the webinar "How Nurses Can Increase Cancer Genetics Service Capacity in a High-Risk Program," presented by Maria Dalmacio, MSN, FNP-B, CN-BP, CBE-C, a high-risk nurse practitioner and cancer risk counselor at Marin General Hospital.

During the event, Dalmacio detailed how she increased the efficiency of her genetic counseling appointments - going from about 1.5 hours per patient to less than 50 minutes each - by adopting genetics specialty software.

Here are three areas in which technology can help streamline the genetics appointment:

1. Family history collection. During an appointment, the genetic specialist may typically spend over 20 minutes collecting family history alongside their patient. With a technology solution, patients should be able to record their family history prior to their appointment.
2. Automatic pedigree maker. Instead of manually drawing a pedigree from scratch for each patient, the patient-entered information automatically generates a pedigree.
3. Test ordering and clinical documentation. Long pre-authorization insurance forms may pile up on your desk, and post-counseling notes need to be written. Software can pre-populate these forms as well as provide standard or custom templates for pre- and post-counseling notes and letters.

Want to streamline your genetics counseling appointments? Watch the recorded webinar to learn how.