ideasIdea
Oncology teams order germline tests; tele-genetic counsellors handle the results
There are too few genetic counsellors to see every patient who should have an inherited-risk test. Let the cancer team order the test with a short consent script, and use video counsellors for those with results that matter.
Mainstreaming, in which oncologists and nurses consent and order germline testing with genetic counselling reserved for positive or complex results, has been shown in ovarian and breast cancer to increase testing rates and shorten time to result without harm. Combined with a pooled tele-genetics service, it would let genetic counsellors cover a much larger population. The proposal is to make this the default pathway with a national tele-genetics roster.
Hypothesis
Mainstreaming plus tele-genetics will increase germline testing among eligible patients from under 40% to above 80% within two years, while keeping counsellor time per tested patient below a third of the traditional pathway.
Rationale
Guideline-eligible testing rates are low everywhere because of counsellor bottlenecks; mainstreaming studies show the workflow is safe and acceptable to patients.
What would test it
Stepped implementation across a regional network measuring testing rate, time to result, cascade testing of relatives, and patient-reported distress.
Maturity
being tested at scale
Who has to act
clinic
Cost to try
Small (under $1M)
Years to first evidence
2
Bottlenecks it attacks
- Not enough oncologists, nurses, pathologists, physicists · The number of people with cancer is rising faster than the workforce trained to treat them.
- Inherited risk is mostly unidentified · Most people who carry a high-risk cancer gene do not know it until they or a relative gets cancer.