Background The majority of hospice admissions have a cancer diagnosis. An estimated 5–10% of cancers have a familial link. Patients have expressed a wish to participate in genetic screening as it may benefit surviving family members through informing subsequent counselling, genetic testing and preventative action. A hospice stay provides an opportunity to explore this. However, genetic referrals from the local hospice were thought to be infrequent with criteria unclear. The audit aimed to assess and improve the proportion of hospice inpatients with cancer who:
had a family history recorded
met a simpler 3–2–1 criteria for genetics referral
were offered genetic screening if appropriate.
Methods The notes of 36 consecutive admissions with a cancer diagnosis were reviewed. Audit standards were not met so change was implemented through installing an electronic prompt for recording family history, teaching sessions for medical staff, and senior review of family history and genetic screening (if appropriate) of all new admissions. Data collection was then repeated.
Results Results showed audit standards were not being met but there was an improvement after interventions. The proportion of patients with family history recorded increased from 19% to 36%. In these patients, the proportion who met the 3-2-1 criteria was 43% initially and then 30% subsequently. Genetics referral was discussed in the notes in 23% of patients, compared to 6% initially.
Conclusion The interventions have improved the recording of patients‘ family history and consideration of referral for genetic screening. The findings were limited by information available but a relatively high proportion of patients met the 3-2-1 criteria, some of whom had not previously had genetic screening discussed, suggesting there is a key role for palliative care in this aspect of patient and family support. Further work will now be undertaken with the regional genetics team related to referral criteria and process.
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