{"entity":{"id":"idea-acc-mainstream-tele-genetic-counselling","kind":"idea","name":"Oncology teams order germline tests; tele-genetic counsellors handle the results","aka":[],"tldr":"There are too few genetic counsellors to see every patient who should have an inherited-risk test. Let the cancer team order the test with a short consent script, and use video counsellors for those with results that matter.","summary":"Mainstreaming, in which oncologists and nurses consent and order germline testing with genetic counselling reserved for positive or complex results, has been shown in ovarian and breast cancer to increase testing rates and shorten time to result without harm. Combined with a pooled tele-genetics service, it would let genetic counsellors cover a much larger population. The proposal is to make this the default pathway with a national tele-genetics roster.","asOf":"2026-09-08","links":[{"label":"Bottleneck evidence (Not enough oncologists, nurses, pathologists, physicists): Yang et al., Projected supply of and demand for oncologists and radiation oncologists through 2025 (JOP 2014)","url":"https://doi.org/10.1200/JOP.2013.001319"}],"tags":[],"related":[],"cancers":["ovarian","breast-hr-positive","colorectal"],"sections":[],"technologies":["germline-testing"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":["b-workforce","b-hereditary-risk"],"keyPapers":["paper-yang-j-oncol-pract"],"journals":[],"dependsOn":[],"notes":[],"hypothesis":"Mainstreaming plus tele-genetics will increase germline testing among eligible patients from under 40% to above 80% within two years, while keeping counsellor time per tested patient below a third of the traditional pathway.","rationale":"Guideline-eligible testing rates are low everywhere because of counsellor bottlenecks; mainstreaming studies show the workflow is safe and acceptable to patients.","test":"Stepped implementation across a regional network measuring testing rate, time to result, cascade testing of relatives, and patient-reported distress.","maturity":"being-tested-at-scale","actor":"clinic","cost":"small","horizonYears":2},"route":"/ideas/idea-acc-mainstream-tele-genetic-counselling/","neighbours":{"cancer":[{"id":"colorectal","kind":"cancer","name":"Colorectal cancer","route":"/cancers/colorectal/"},{"id":"breast-hr-positive","kind":"cancer","name":"HR-positive / HER2-negative breast cancer","route":"/cancers/breast-hr-positive/"},{"id":"ovarian","kind":"cancer","name":"Ovarian cancer","route":"/cancers/ovarian/"}],"technology":[{"id":"germline-testing","kind":"technology","name":"Germline (hereditary) testing","route":"/technologies/germline-testing/"}],"bottleneck":[{"id":"b-hereditary-risk","kind":"bottleneck","name":"Inherited risk is mostly unidentified","route":"/bottlenecks/b-hereditary-risk/"},{"id":"b-workforce","kind":"bottleneck","name":"Not enough oncologists, nurses, pathologists, physicists","route":"/bottlenecks/b-workforce/"}],"paper":[{"id":"paper-yang-j-oncol-pract","kind":"paper","name":"Projected supply of and demand for oncologists and radiation oncologists through 2025: an aging, better-insured population will result in shortage","route":"/key-papers/paper-yang-j-oncol-pract/"}]}}