Journal: Journal of genetic counseling
This publication describes the design and early outcomes of a “Fast-Track” coordinator-based model for delivering hereditary cancer germline testing within a comprehensive cancer genetics program.
Key points:
- Rationale: Demand for germline testing has risen sharply, while the availability of genetic counselors is limited. The program aims to preserve quality while increasing throughput and reducing wait times.
- Model structure:
- • Referrals to the cancer genetics program are reviewed and triaged by genetic counselors.
- • Patients who meet NCCN criteria for germline testing are assigned to the Fast-Track pathway.
- • Patients receive standardized pre-test education via a program-specific video.
- • Trained genetics clinical coordinators (non-GC staff) handle pre-test education, consent, and test coordination.
- • Genetic counselors review all cases after the initial visit (whether or not testing is completed) and provide management recommendations.
- • Patients with pathogenic/likely pathogenic variants or complex results have results disclosed directly by a genetic counselor; all others receive results from the coordinators under GC oversight.
- Implementation and early outcomes (6/12/2023–3/29/2024):
- • 415 patients were seen in the Fast-Track pathway over 9 months.
- • 12.3% of those tested had a pathogenic or likely pathogenic germline variant.
- • Time from referral to appointment was significantly reduced compared with the standard genetic counselor pathway (mean ~22 days vs ~90 days; p < 0.001).
- Conclusions:
- • A coordinator-based model, with genetic counselor oversight, can substantially shorten access time to germline testing while maintaining triage and oversight by genetics professionals.
- • The program is expanding institutionally.
- • Further work is needed to assess additional quality metrics, including patient satisfaction, to fully evaluate the model’s impact.