EVALUATION OF NURSE-LED APPROACHES IN THE GENETIC TESTING PATHWAY IN BREAST CANCER CARE

• Published in: Oncology nursing forum Vol. 50; no. 2; pp. C58 - C59
• Main Authors: Brennan-Doran, Colleen, Adomah, Sarah, Ballestero, Eduard Perez, Kruss, Gillian, van Rosmalen, Mandy
• Format: Journal Article
• Language: English
• Published: Pittsburgh Oncology Nursing Society 01.03.2023
• Subjects: Breast cancer; Continuity of care; Genetic testing; Genetics; Nurses; Oncology; Patients; Teams
• ISSN: 0190-535X; 1538-0688

Screening, Early Detection, and Genetic Risk Germline testing for breast cancer gene (BRCA) 1 and/or 2 mutation (gBRCAm) is now a key part of HER2-negative breast cancer care due to its impact on access to targeted therapies, surgery and downstream cancer prevention for patients and family members. Historically gBRCAm testing has been led by genetics teams. However increasingly, nurses amongst other members of the multidisciplinary team (MDT) have taken on elements of the testing pathway with the goal of expanding and streamlining access to testing services. The purpose was to assess the benefit of nurse-led approaches in the gBRCAm testing pathway in HER2-negative breast cancer. PubMed and key cancer congresses (ASCO, ESMO, ESMO Breast and SABCS) were searched between 1 Jan 2000 and 5 Sept 2022 to identify relevant publications using the following search terms: "Nurse and BRCA", "breast cancer nurse and BRCA", "clinical nurse specialist and BRCA", "nurse and BRCA testing pathway." Twenty-two unique articles/congress abstracts were identified. These demonstrated that involving specialist breast cancer care nurses can streamline the genetic testing pathway and help provide patients with continuity of care. Key findings included: 1) that it is possible to integrate genetic testing into routine oncology clinics through a 'mainstreaming' approach, allowing involvement of the MDT; 2) nurses can play a key role in the genetic testing pathway through a mainstreaming approach, and this is acceptable to patients and physicians; 3) nurses can be involved at several stages of the testing pathway including gaining consent from patients, pre- and posttest counselling, obtaining patient samples, returning test results to patients and continued care of patients following receipt of their gBRCAm testing results; and 4) nurse-led decision coaching may enhance shared decision-making for patients with breast cancer. Furthermore, the genetics team should be involved throughout the genetic testing pathway but particularly when tests results are shared with patients to support interpretation, provide patient counselling and management of familial identification. The gBRCAm testing pathway for breast cancer care could be improved and streamlined by increasing nurse involvement. However, nurses need to receive specialist training and educational materials to build their knowledge and skillset. Further studies are warranted to better understand the roles that the nurse can play in the gBRCAm testing pathway. Improved collaboration between genetics teams, physicians and nurses will provide the optimal streamlined gBRCAm testing pathway.