Telehealth Cancer Genetics – Case Management; first appointment

1. POLICY STATEMENT:

This policy aims to assist clinical management of the first telehealth appointment in a timely, efficient and effective manner.

2. SUMMARY:

This policy summarises the management of the Hereditary Cancer patient after Intake and during the first telehealth appointment.

3. RESPONSIBILITIES:

Before first appointment is allocated, the genetic counsellor will discuss the Intake with the supervising clinician to determine the following:

  • Level of case triage for appointment (see definitions)
  • Status of verification of cancers
  • Diagnostic testing to be ordered before appointment (including tissue immunohistochemistry)
  • Alerts to existing psychosocial issues, such as high anxiety levels or grief
  • Results of applicable risk management algorithms (e.g. Boadicea, Manchester, PREM126)
  • Ensure clinician is aware of particular client concerns e.g. need to discuss prophylactic surgery
  • Availability of telehealth appointment

Once appointment is allocated the genetic counsellor will prepare the file for clinic

  • Ensure contact details, relevant medical history and referring/consulting doctor details up to date in file
  • Ensure client details are entered on to electronic databases
  • Build pedigree on pedigree-drawing software
  • Ensure pathology results, tissue testing results etc. are available in the file
  • If genetic testing is to be performed as part of the consultation, the genetic counsellor will arrange for relevant paperwork to be at hand

During first appointment

  • The accompanying genetic counsellor will introduce/summarise the case for the clinician in the presence of the patient
  • The clinician will review the family history and its implications with the client and provide recommendations for follow-up and will note this in the clinical progress notes
  • The clinician will make recommendations for further referral where relevant
  • At the close of the appointment, the clinician or the genetic counsellor will review the follow-up plan with the client and discuss any further concerns the client has
  • The genetic counsellor will accompany the client from the room to ensure he/she has safe exit from the clinic, while the doctor dictates the patient/doctor letters.

After the first appointment

  • Follow-up plan will be reviewed and actioned by the clinician and the genetic counsellor during scheduled Clinic Review meetings.

4. DEFINITIONS:

Triage:

Urgent (within two weeks where possible)

Semi-urgent (within four weeks where possible)

Standard (within six weeks where possible)

REFERENCES: Draft SESIAHS Document SESLHNDP05Cancer Genetics – Case Management; first appointment