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Barriers and Facilitators to Adoption of Genomic Services for Colorectal Care within the Veterans Health Administration

We examined facilitators and barriers to adoption of genomic services for colorectal care, one of the first genomic medicine applications, within the Veterans Health Administration to shed light on areas for practice change. We conducted semi-structured interviews with 58 clinicians to understand us...

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Autores principales: Sperber, Nina R., Andrews, Sara M., Voils, Corrine I., Green, Gregory L., Provenzale, Dawn, Knight, Sara
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4932463/
https://www.ncbi.nlm.nih.gov/pubmed/27136589
http://dx.doi.org/10.3390/jpm6020016
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author Sperber, Nina R.
Andrews, Sara M.
Voils, Corrine I.
Green, Gregory L.
Provenzale, Dawn
Knight, Sara
author_facet Sperber, Nina R.
Andrews, Sara M.
Voils, Corrine I.
Green, Gregory L.
Provenzale, Dawn
Knight, Sara
author_sort Sperber, Nina R.
collection PubMed
description We examined facilitators and barriers to adoption of genomic services for colorectal care, one of the first genomic medicine applications, within the Veterans Health Administration to shed light on areas for practice change. We conducted semi-structured interviews with 58 clinicians to understand use of the following genomic services for colorectal care: family health history documentation, molecular and genetic testing, and genetic counseling. Data collection and analysis were informed by two conceptual frameworks, the Greenhalgh Diffusion of Innovation and Andersen Behavioral Model, to allow for concurrent examination of both access and innovation factors. Specialists were more likely than primary care clinicians to obtain family history to investigate hereditary colorectal cancer (CRC), but with limited detail; clinicians suggested templates to facilitate retrieval and documentation of family history according to guidelines. Clinicians identified advantage of molecular tumor analysis prior to genetic testing, but tumor testing was infrequently used due to perceived low disease burden. Support from genetic counselors was regarded as facilitative for considering hereditary basis of CRC diagnosis, but there was variability in awareness of and access to this expertise. Our data suggest the need for tools and policies to establish and disseminate well-defined processes for accessing services and adhering to guidelines.
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spelling pubmed-49324632016-07-13 Barriers and Facilitators to Adoption of Genomic Services for Colorectal Care within the Veterans Health Administration Sperber, Nina R. Andrews, Sara M. Voils, Corrine I. Green, Gregory L. Provenzale, Dawn Knight, Sara J Pers Med Article We examined facilitators and barriers to adoption of genomic services for colorectal care, one of the first genomic medicine applications, within the Veterans Health Administration to shed light on areas for practice change. We conducted semi-structured interviews with 58 clinicians to understand use of the following genomic services for colorectal care: family health history documentation, molecular and genetic testing, and genetic counseling. Data collection and analysis were informed by two conceptual frameworks, the Greenhalgh Diffusion of Innovation and Andersen Behavioral Model, to allow for concurrent examination of both access and innovation factors. Specialists were more likely than primary care clinicians to obtain family history to investigate hereditary colorectal cancer (CRC), but with limited detail; clinicians suggested templates to facilitate retrieval and documentation of family history according to guidelines. Clinicians identified advantage of molecular tumor analysis prior to genetic testing, but tumor testing was infrequently used due to perceived low disease burden. Support from genetic counselors was regarded as facilitative for considering hereditary basis of CRC diagnosis, but there was variability in awareness of and access to this expertise. Our data suggest the need for tools and policies to establish and disseminate well-defined processes for accessing services and adhering to guidelines. MDPI 2016-04-28 /pmc/articles/PMC4932463/ /pubmed/27136589 http://dx.doi.org/10.3390/jpm6020016 Text en © 2016 by the authors; licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Sperber, Nina R.
Andrews, Sara M.
Voils, Corrine I.
Green, Gregory L.
Provenzale, Dawn
Knight, Sara
Barriers and Facilitators to Adoption of Genomic Services for Colorectal Care within the Veterans Health Administration
title Barriers and Facilitators to Adoption of Genomic Services for Colorectal Care within the Veterans Health Administration
title_full Barriers and Facilitators to Adoption of Genomic Services for Colorectal Care within the Veterans Health Administration
title_fullStr Barriers and Facilitators to Adoption of Genomic Services for Colorectal Care within the Veterans Health Administration
title_full_unstemmed Barriers and Facilitators to Adoption of Genomic Services for Colorectal Care within the Veterans Health Administration
title_short Barriers and Facilitators to Adoption of Genomic Services for Colorectal Care within the Veterans Health Administration
title_sort barriers and facilitators to adoption of genomic services for colorectal care within the veterans health administration
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4932463/
https://www.ncbi.nlm.nih.gov/pubmed/27136589
http://dx.doi.org/10.3390/jpm6020016
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