Patients who are eligible for genetic testing fall on a spectrum of risk and needs. The term, “high-risk,” can describe a range of hereditary and non-hereditary cancer risk levels. While some patients with strong genetic risk factors require intensive genetic counseling, others who have relatively low genetic risk may still benefit from genetic testing. For example, genetic testing is the standard of care for patients with some forms of cancer but no pertinent family history. These patient populations need timely access to genetic counseling to avoid delays in care.

St. Joseph Hospital recognized that one way to meet patient need while combating genetic counselor capacity shortages was by foregoing a “one-sizefits-all” approach, and instead stratifying patients by risk level. They developed an expedited process for certain subsets of patients who would not find as much value in the conventional, time-intensive genetic counseling session, and in turn accommodated more patients in their schedules.

Their team of genetic counselors focused on carefully identifying the right patients for the accelerated pathway to ensure that they did not neglect the needs of higher-risk patients.

The first subset of patients eligible for the fast-tracked genetic counseling clinic are patients diagnosed with cancer. These patients are frequently older, may not have pertinent family histories, and would prefer to avoid additional appointments. While their treatment may be informed by genetic testing, the patient does not necessarily need a full genetic consultation. These patients have access to the walk-in clinic and often arrive after a scheduled visit with their oncologist.

St. Joseph Hospital also offers patients access to same-day genetics services at the time of breast biopsy. In recent years, some organizations have expanded recommendations that genetic testing be made available for all patients diagnosed with breast cancer. By getting patients into the walk-in genetic counseling clinic at this early stage, St. Joseph Hospital is able to jump-start the treatment planning process without delays for genetic testing if the patient is diagnosed with cancer.

Many patients appreciate having the option to receive immediate genetic testing and “cover their bases” when it comes to determining their cancer risk, even if the results of the biopsy are benign. In instances where the biopsy indicates that the breast mass is cancerous, St. Joseph Hospital’s patients have already completed genetic testing, which can inform treatment choices, thus decreasing the time from diagnosis to treatment start.

After establishing the walk-in genetic counseling clinic for cancer patients and patients undergoing breast biopsy, St. Joseph Hospital expanded the system to eligible patients identified at the time of their screening mammogram and endoscopy, as well as some unaffected patients in the general population who are concerned about their cancer risk.

Fast-tracked genetic counseling is not appropriate for all patients, and many benefit from more extensive counseling and relationship-building with the genetic counselor. St. Joseph Hospital’s genetic counselors continually assess individualized patient risk factors to determine the suitability of the streamlined sessions compared to standard appointments. It’s important to carefully consider the needs of your patient population when considering the implementation of St. Joseph Hospital’s alternative model.

To increase the efficiency of their walk-in visits, St. Joseph Hospital genetic counselors use standardized materials that help to cut down on preparation and appointment length.

After the patient is roomed in the walk-in clinic, they view a standardized educational video about hereditary cancer risk and the implications of genetic testing. The patient then completes a short questionnaire that quickly assesses their risk of developing cancer and testing eligibility. This questionnaire is an abbreviated version of the more comprehensive risk assessment that St. Joseph Hospital administers to patients prior to a conventional genetic counseling appointment, which provides additional detail for a formal genetic cancer risk assessment.

A genetic counselor reviews and oversees the case and coordinates testing. If the patient is eligible and consents to genetic testing, the staff collects the saliva sample, and prepares it to send to the lab.

In the event that the patient does not have coverage through their insurer, the maximum out of pocket fee is capped at $250 to ensure the genetic testing is affordable for patients.

The standardization of these materials in the walk-in model allows the visit to take place in a shorter window of time, without sacrificing genetic counselor oversight, the content of the patient education, or personalized follow-up.

In comparison, a traditional genetic counseling appointment requires a significant investment of time per patient for preparation and a more intensive conversation about the implications of hereditary risk for the patient’s family. While many patients certainly benefit from this more intensive counseling process, there are some who prefer the convenient access to the service.

St. Joseph Hospital employs genetic counseling assistants (GCAs) to increase genetic counselors’ capacity to see more patients. The program rigorously trains their GCAs and carefully defines their role to enable them to best support the team’s genetic counselors.

The walk-in clinic is primarily staffed by GCAs who meet with the patients to administer the risk assessment, play the educational video, and to collect the saliva sample. Throughout, the GCAs remain closely supervised by a genetic counselor. The genetic counselor is able to supervise multiple GCAs at once and ensure that all testing is coordinated appropriately and correctly documented. 

The genetic counselor delivers the results to the patient, reviews pertinent personal and family history, recommends follow-up, and provides formal post-test genetic counseling, as needed. Each patient accounts for only 15 minutes of the genetic counselor’s time prior to administering the test in the expedited pathway because of the support from the GCA. Conversely, in a conventional appointment, the genetic counselor would spend about 2 hours preparing for the appointment, meeting with the patient, coordinating testing, and completing consultation notes.

Because the walk-in genetic counseling session is more efficient than a conventional appointment, the GCAs are able meet with patients, take care of prep work, and lead education, thus allowing the genetic counselors to work at top-of-license, supporting genetic excellence throughout the cancer center.