title: A cancer genetics toolkit improves access to genetic services through documentation and use of the family history by primary-care clinicians.
abstract: OBJECTIVE
  We developed, implemented, and evaluated a multicomponent cancer genetics toolkit designed to improve recognition and appropriate referral of individuals at risk for hereditary cancer syndromes.
  
  
  METHODS
  We evaluated toolkit implementation in the women's clinics at a large Veterans Administration medical center using mixed methods, including pre-post semistructured interviews, clinician surveys, and chart reviews, and during implementation, monthly tracking of genetic consultation requests and use of a reminder in the electronic health record. We randomly sampled 10% of progress notes 6 months before (n = 139) and 18 months during implementation (n = 677).
  
  
  RESULTS
  The toolkit increased cancer family history documentation by almost 10% (26.6% pre- and 36.3% postimplementation). The reminder was a key component of the toolkit; when used, it was associated with a twofold increase in cancer family history documentation (odds ratio = 2.09; 95% confidence interval: 1.39-3.15), and the history was more complete. Patients whose clinicians completed the reminder were twice as likely to be referred for genetic consultation (4.1-9.6%, P < 0.0001).
  
  
  CONCLUSIONS
  A multicomponent approach to the systematic collection and use of family history by primary-care clinicians increased access to genetic services.
authors.affiliation: 1] VA Greater Los Angeles Healthcare System, Los Angeles, California, USA [2] Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
authors.forename: Maren T
authors.initials: MT
authors.lastname: Scheuner
authors.affiliation: 1] VA Greater Los Angeles Healthcare System, Los Angeles, California, USA [2] Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
authors.forename: Alison B
authors.initials: AB
authors.lastname: Hamilton
authors.affiliation: VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.
authors.forename: Jane
authors.initials: J
authors.lastname: Peredo
authors.affiliation: VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.
authors.forename: Taylor J
authors.initials: TJ
authors.lastname: Sale
authors.affiliation: VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.
authors.forename: Colletta
authors.initials: C
authors.lastname: Austin
authors.affiliation: Office of Academic Affiliations, Veterans Health Administration, Washington DC, USA.
authors.forename: Stuart C
authors.initials: SC
authors.lastname: Gilman
authors.affiliation: Office of Public Health Genomics, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: M Scott
authors.initials: MS
authors.lastname: Bowen
authors.affiliation: 1] VA Greater Los Angeles Healthcare System, Los Angeles, California, USA [2] Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
authors.forename: Caroline Lubick
authors.initials: CL
authors.lastname: Goldzweig
authors.affiliation: 1] VA Greater Los Angeles Healthcare System, Los Angeles, California, USA [2] UCLA Fielding School of Public Health, Los Angeles, California, USA.
authors.forename: Martin
authors.initials: M
authors.lastname: Lee
authors.affiliation: VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.
authors.forename: Brian S
authors.initials: BS
authors.lastname: Mittman
authors.affiliation: 1] VA Greater Los Angeles Healthcare System, Los Angeles, California, USA [2] UCLA Fielding School of Public Health, Los Angeles, California, USA.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Yano
mesh_terms: D003123:Colorectal Neoplasms, Hereditary Nonpolyposis / Q000235:genetics*; D004282:Documentation / Q000379:methods*; D057286:Electronic Health Records; D005192:Family Health; D005260:Female; D033142:Genetic Services; D061325:Hereditary Breast and Ovarian Cancer Syndrome / Q000235:genetics*; D006787:Hospitals, Veterans; D006801:Humans; D007407:Interviews as Topic; D008487:Medical History Taking; D011320:Primary Health Care; D017010:Reminder Systems