The knowledge value-chain of genetic counseling for breast cancer: an empirical assessment of prediction and communication processes.
The aim of this paper is twofold: to analyze the genetic counseling process for breast cancer with a theoretical knowledge transfer lens and to compare generalists, medical specialists, and genetic counselors with regards to their genetic counseling practices. This paper presents the genetic counseling process occurring within a chain of value-adding activities of four main stages describing health professionals' clinical practices: (1) evaluation, (2) investigation, (3) information, and (4) decision. It also presents the results of a cross-sectional study based on a Canadian medical doctors and genetic counselors survey (n = 176) realized between July 2012 and March 2013. The statistical exercise included descriptive statistics, one-way ANOVA and post-hoc tests. The results indicate that even though all types of health professionals are involved in the entire process of genetic counseling for breast cancer, genetic counselors are more involved in the evaluation of breast cancer risk, while medical doctors are more active in the decision toward breast cancer risk management strategies. The results secondly demonstrate the relevance and the key role of genetic counselors in the care provided to women at-risk of familial breast cancer. This paper presents an integrative framework to understand the current process of genetic counseling for breast cancer in Canada, and to shed light on how and where health professionals contribute to the process. It also offers a starting point for assessing clinical practices in genetic counseling in order to establish more clearly where and to what extent efforts should be undertaken to implement future genetic services.
Department of Management, Pavillon Palasis-Prince, Laval University, 2325, rue de la Terrasse, Local 1516, Quebec, QC, G1V 0A6, Canada. Nabil.amara@fsa.ulaval.ca.
Nabil
N
Amara
Department of Management, Pavillon Palasis-Prince, Laval University, 2325, rue de la Terrasse, Local 1516, Quebec, QC, G1V 0A6, Canada. Jolyane.blouin-bougie@fsa.ulaval.ca.
Jolyane
J
Blouin-Bougie
New Brunswick Medical Training Centre and School of Psychology, University of Monction, Moncton, NB, Canada. jalila.jbilou@umoncton.ca.
Jalila
J
Jbilou
Department of Management, Pavillon Palasis-Prince, Laval University, 2325, rue de la Terrasse, Local 1516, Quebec, QC, G1V 0A6, Canada. Norrin.halilem@fsa.ulaval.ca.
Norrin
N
Halilem
Cancer Genomics Laboratory, Department of Molecular Medicine, Laval University, Quebec, QC, Canada. jacques.simard@crchul.ulaval.ca.
Jacques
J
Simard
Department of Management, Pavillon Palasis-Prince, Laval University, 2325, rue de la Terrasse, Local 1516, Quebec, QC, G1V 0A6, Canada. Rejean.landry@fsa.ulaval.ca.
Réjean
R
Landry
D001943:Breast Neoplasms / Q000235:genetics*; D002170:Canada; D003430:Cross-Sectional Studies; D005260:Female; D005817:Genetic Counseling / Q000379:methods / Q000458:organization & administration; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel; D006801:Humans; D008495:Medical Oncology / Q000458:organization & administration*; D010820:Physicians; D018570:Risk Assessment
Canadian health care providers; Familial breast cancer; Genetic counseling; Knowledge management; Knowledge value chain; Risk communication; Risk prediction