title: The integration of BRCA testing into oncology clinics.
abstract: OBJECTIVE
  The PARP inhibitor, Olaparib, is approved for women with BRCA-mutated ovarian cancer. Therefore there is an urgent need to test patients and obtain results in time to influence treatment. Models of BRCA testing, such as the mainstreaming oncogenetic pathway, involving oncology health professionals are being used. The authors report on the establishment of the extended role of the clinical nurse specialist in consenting women for BRCA testing in routine gynaecology-oncology clinics using the mainstreaming model.
  
  
  METHODS
  Nurses undertook generic consent training and specific counselling training for BRCA testing in the form of a series of online videos, written materials and checklists before obtaining approval to consent patients for germline BRCA1 and BRCA2 mutations.
  
  
  RESULTS
  Between July 2013 and December 2015, 108 women with ovarian cancer were counselled and consented by nurses in the medical oncology clinics at a single centre (The Royal Marsden, UK). This represented 36% of all ovarian cancer patients offered BRCA testing in the oncology clinics at the centre. Feedback from patients and nurses was encouraging with no significant issues raised in the counselling and consenting process.
  
  
  CONCLUSIONS
  The mainstreaming model allows for greater access to BRCA testing for ovarian cancer patients, many of whom may benefit from personalised therapy (PARP inhibitors). This is the first report of oncology nurses in the BRCA testing pathway. Specialist oncology nurses trained in BRCA testing have an important role within a multidisciplinary team counselling and consenting patients to undergo BRCA testing.
authors.affiliation: Advanced Nurse Practitioner, Gynaecology Unit, The Royal Marsden NHS Foundation Trust.
authors.forename: Natalie
authors.initials: N
authors.lastname: Percival
authors.affiliation: Consultant Oncogenetics, Gynaecology Unit, The Royal Marsden NHS Foundation Trust and Division of Genetics and Epidemiology, The Institute of Cancer Research, London.
authors.forename: Angela
authors.initials: A
authors.lastname: George
authors.affiliation: Research Nurse, Gynaecology Unit, The Royal Marsden NHS Foundation Trust.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Gyertson
authors.affiliation: Research Nurse, Gynaecology Unit, The Royal Marsden NHS Foundation Trust.
authors.forename: Monica
authors.initials: M
authors.lastname: Hamill
authors.affiliation: Clinical Nurse Specialist, Gynaecology Unit, The Royal Marsden NHS Foundation Trust.
authors.forename: Andreia
authors.initials: A
authors.lastname: Fernandes
authors.affiliation: Clinical Nurse Specialist, Gynaecology Unit, The Royal Marsden NHS Foundation Trust.
authors.forename: Emily
authors.initials: E
authors.lastname: Davies
authors.affiliation: Professor of Genetics, The Royal Marsden NHS Foundation Trust and Division of Genetics and Epidemiology, The Institute of Cancer Research, London.
authors.forename: Nazneen
authors.initials: N
authors.lastname: Rahman
authors.affiliation: Consultant Medical Oncologist, Gynaecology Unit, The Royal Marsden NHS Foundation Trust, The Institute of Cancer Research, London.
authors.forename: Susana
authors.initials: S
authors.lastname: Banerjee
mesh_terms: D002173:Cancer Care Facilities; D005260:Female; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D005820:Genetic Testing / Q000379:methods*; D061325:Hereditary Breast and Ovarian Cancer Syndrome / Q000175:diagnosis* / Q000235:genetics; D006801:Humans; D007258:Informed Consent; D009154:Mutation; D009720:Nurse Clinicians; D024802:Nurse's Role; D009859:Oncology Nursing / Q000379:methods*; D010051:Ovarian Neoplasms / Q000188:drug therapy / Q000235:genetics*; D017060:Patient Satisfaction; D010793:Phthalazines / Q000627:therapeutic use; D010879:Piperazines / Q000627:therapeutic use; D000067856:Poly(ADP-ribose) Polymerase Inhibitors / Q000627:therapeutic use; D057285:Precision Medicine / Q000379:methods*
chemical_list: D010793:Phthalazines; D010879:Piperazines; D000067856:Poly(ADP-ribose) Polymerase Inhibitors; C531550:olaparib
keywords: BRCA; Clinical nurse specialist; Family history; Genetic testing; Ovarian cancer