title: Errors in delivery of cancer genetics services: implications for practice.
abstract: Advances in genetics have prompted recommendations that all healthcare providers perform genetic counseling and testing. Some experts are concerned about potential negative outcomes from cancer genetic testing performed without genetic counseling by certified genetics professionals. We report a national series of cases illustrating negative outcomes of cancer genetic testing performed without counseling by a qualified provider. Three major patterns emerged from analysis of these cases: 1) Wrong genetic test ordered, 2) Genetic test results misinterpreted, and 3) Inadequate genetic counseling. Negative outcomes included unnecessary prophylactic surgeries, unnecessary testing, psychosocial distress, and false reassurance resulting in inappropriate medical management.
  
  
  CONCLUSIONS
  With the complexities of cancer genetic counseling and testing, it may be unrealistic to expect all clinicians to provide these services. A more realistic approach is better provider education and a framework in which healthcare providers identify patients who would benefit from a referral to a certified genetic counselor or experienced cancer genetics professional.
authors.affiliation: Yale Cancer Center, Yale University School of Medicine, New Haven, CT 06510, USA.
authors.forename: Karina L
authors.initials: KL
authors.lastname: Brierley
authors.forename: Danielle
authors.initials: D
authors.lastname: Campfield
authors.forename: Whitney
authors.initials: W
authors.lastname: Ducaine
authors.forename: Lindsay
authors.initials: L
authors.lastname: Dohany
authors.forename: Talia
authors.initials: T
authors.lastname: Donenberg
authors.forename: Kristen
authors.initials: K
authors.lastname: Shannon
authors.forename: Robin C
authors.initials: RC
authors.lastname: Schwartz
authors.forename: Ellen T
authors.initials: ET
authors.lastname: Matloff
mesh_terms: D003951:Diagnostic Errors; D005260:Female; D052138:Genes, Neoplasm / Q000235:genetics*; D005817:Genetic Counseling / Q000592:standards*; D005820:Genetic Testing / Q000592:standards*; D006801:Humans; D008297:Male