TABLE 2: Summary of major findings of the included 44 studies
Authors / Location / Participants / Study design / Main resultsProws and Latta, 1995 / United States / · 28 staff-registered nurses from a children’s hospital medical center.
· Age: Not reported
· Race/Ethnicity: Not reported
· Years of practice: Not reported / Pre/post design with three-, six- and 12 month follow-ups / · Knowledge:
–Knowledge significantly increased from pre-test to post-test scores.
· Practice behavior:
–Total number of genetic services continuously increased in three- and six-month follow-ups.
· Program assessment:
–Comments about the workshop were generally positive.
–Although overall positive response, mixed comments about the preceptorship.
Huang et al., 1997 / Taiwan / · 361 community health nurses and 74 maternal-child nurses.
· Age: Median age = 30 years old (range 20-47), for community health nurses and median age = 25 years old (range 22-38) for maternal-child nurses
· Race/Ethnicity: Not reported
· Years of practice: Not reported
/ One-shot case study/descriptive cross-sectional / · Knowledge:
–Significantly higher scores for community health nurses versus maternal-child nurses.
Kolb et al., 1999 / United States / · 121 primary healthcare providers from community health clinics (n = 85 registered nurses, n = 19 physicians, n = 8 vocational nurses, n = 8 social workers, and n = 1 dietitian).
· Age: Not reported
· Race/Ethnicity: Not reported
· Years of practice: Not reported / Pre/post design / · Knowledge:
–Significantly increased from pre-test to post-test scores.
· Attitudes:
–Significantly improved toward providing genetic services from pre-test to post-test scores.
Gaff et al., 2001 / Australia / · 10 oncology nurses attended a cancer genetics resource training course.
· Age: Not reported
· Race/Ethnicity: Not reported
· Years of practice: Not reported / One-shot case study/descriptive cross-sectional with 6-month follow-up / · Skills:
–Counseling skills increased.
· Practice behavior:
–Increased genetics practice behavior (e.g., referring patients to an appropriate provider and applying new skills in practice).
· Program assessment:
–General satisfaction with the course (e.g. content usefulness, quality of teaching, relevance to work).
Swank et al., 2001 / United States / · 100 registered nurses working at 177 reproductive health centers completed the baseline study (pre-test). Among them, 65 completed the post-test survey.
· Age: Not reported
· Race/Ethnicity: Not reported
· Years of practice: Practicing nurses for 16.9 years on average (SD = 9.9, range: 1-35 years) and practicing IVF nurses for 5.8 years on average (SD = 4.7, range: 0.1-16 years) / Pre/post design / · Knowledge:
–Significantly increased from pre-test to post-test scores.
· Self-efficacy:
–Significantly increased from pre-test to post-test scores in identifying egg donors’ genetic risks.
· Program assessment:
–Exceptionally positive comments regarding the education in various aspects (e.g., content, format, and meeting learning objectives). Suggestions came from several participants regarding specific topics and delivery methods for future education.
Masny et al., 2003 / United States / · 164 oncology nurses, who had more than 2 years of experience in oncology, were recruited by mail and word of mouth in five U.S. states to attend the familial cancer risk assessment course and completed a baseline survey. 141 nurses completed a post-test evaluation for the changes of cancer genetics knowledge. 100 nurses completed a post-test survey 6 months later for assessing the nurse’s role in the cancer risk assessment.
· Age: Not reported
· Race/Ethnicity: Not reported
· Years of practice: 11 years (range: 1-28 years) / Pre/post design with a 6-month follow- up / · Knowledge:
–Significantly increased from pre-test to post-test scores.
· Self-efficacy:
–Significant increase from pre-test to six-month post-test in cancer family history taking, risk assessment based on family history, and follow-up recommendations.
· Practice behavior:
–Significant increase from pre-test to six-month post-test in collecting certain family histories and using certain methods to evaluate patients’ cancer risk. The number of participants that “utilized the family pattern of cancer (p < .001) and information from genetic testing information (p ≤ 0.01) for communicating cancer risk” also significantly increased.
Blazer et al., 2004 / United States / · 710 community-based clinicians (mainly primary care physicians, gynecologists, oncologists, gastrointestinal specialists, and other physicians, nurses, and genetic counselors) attended either 1-hour seminars or a full-day conference. 69 clinicians completed the long-term (11-month) follow-up survey.
· Age: Not reported
· Race/Ethnicity: Not reported
· Years of practice: Not reported / Pre/post design with an 11-month follow-up / · Knowledge:
–Significantly increased from pre-test to post-test scores for physicians, nurses, and genetic counselors.
· Practice behavior:
–Follow-up survey indicated that overall 1) 77% of participants “used course information and referral guidelines to counsel patients about risk or to refer patients for further risk assessment” and 2) 80% of participants “shared the information with other clinicians.”
· Program assessment:
–General satisfaction with the curriculum (e.g., content, delivery, and relevance to practice).
Blazer et al., 2005 / United States / · 23 genetic counselors, 14 advanced practitioner nurses, and 3 physicians in clinical genetics practice passed a competitive selection process to attend the cancer genetics education program. Attendees filled out the post-course survey 6 months (n = 35) and 1 year (n = 29) after the program.
· Age: Not reported
· Race/Ethnicity: Not reported
· Years of practice: Not reported / Pre/post design with 6-month and one-year follow-up / · Knowledge:
–Significantly increased from pre-test to post-test scores.
· Self-efficacy:
–One year after the course, participants stated that the educational experience increased their self-efficacy in cancer genetics practice (76%) and cancer risk assessment and recommendation skills (62%).
· Practice behavior:
–One year after the course, 35 participants were “actively practicing cancer risk assessment” and 19 saw more patients for cancer risk assessments.
· Program assessment:
–General satisfaction with the course among participants.
Macri et al., 2005 / United States / · 28 obstetrician-gynecologist residents at an urban, university-based residency program.
· Age: Not reported
· Race/Ethnicity: Not reported
· Years of practice: Not reported / Pre/post design / · Knowledge:
–Significantly increased from pre-test to post-test scores.
· Self-efficacy:
–Majority of the participants indicated that the training enhanced their confidence in family history taking, pedigree drawing, Web-based resource searching, and patient counseling.
· Program assessment:
–Most participants highly rated the program.
Bodzin, 2005 / United States / · 41 health professionals (52% working in public health practice/research, 24% healthcare provision, and other fields such as nursing, education, counseling, and basic sciences) watched the Module 1 of “Six Weeks to Genomics Awareness” Web-based training.
· Age: Not reported
· Race/Ethnicity: Not reported
· Years of practice: Majority (63%) more than 10 years / One-shot case study/descriptive cross-sectional / · Knowledge
–On a 10-point scale, participants reported about a 7-point score, indicating that the training enhanced their genomics knowledge.
· Self-efficacy
–Majority of the participants did not feel confident enough to apply knowledge to their practice settings.
· Program assessment:
–Most participants highly rated the module.
Bell et al., 2007 / United States / · 171 nurses (mainly registered nurses working in an acute care setting) attended a regional psychiatric conference entitled, “Mental Health Nursing and Genomics.” 119 completed both pre- and immediate post-conference surveys, and 59 filled out a 3-month follow-up survey.
· Age: Not reported
· Race/Ethnicity: Not reported
· Years of practice: More than 9 years / Pre/post design with a 3-month follow-up / · Knowledge:
–Significantly increased from pre-test to post-test scores and was maintained from the post-test to the follow-up.
· Practice behavior:
–From the pre-test to follow-up, there was an increase in using genomics information for self-education (~30% increase), patient education (10% increase), and education for colleagues (29% increase).
–From the pre-test to the follow-up, there was an increase in positive response to this statement: “the patient population with whom I work has experienced genetic testing.”
Clyman et al., 2007 / United States / · 143 general practitioners (68 physicians and 75 family practice residents) at the Mid-Hudson Family Health Institute
· Age: Not reported
· Race/Ethnicity: Not reported
· Years of practice: Not reported / Pre/post design / · Knowledge:
–Significantly increased from pre-test to post-test scores.
· Program assessment:
–Lectures were perceived as useful, easily understandable, of good quality, and impacting medical practice by most participants.
Mrazek et al., 2007 / United States / · 41 physicians (psychiatrists and others), nurses, social workers, psychologists, researchers, and other mental health professionals at the Mayo Clinic
· Age: Mean = 52.5 years old
· Race/Ethnicity: Not reported
· Years of practice: Not reported / One-shot case study/descriptive cross-sectional / · Attitudes:
–Religion, age, and gender affected
participants’ attitudes toward clinical
genetic testing (post-test data).
Altshuler et al., 2008 / United States / · 60 pediatric residents at the Maimonides Infants & Children’s Hospital
· Age: Not reported
· Race/Ethnicity: Not reported
· Years of practice: Not reported / Pre/post design / · Comfort level:
–Significantly increased in genetic clinical skills overall and in 5 of 12 specific tasks (pre-/post-test analysis).
· Program assessment:
–Participants reported valuable training experience (i.e., being relevant to clinical work, containing new information, and providing fair and valuable feedback, with intention to participate again).
Bethea et al., 2008 / United Kingdom / · 217 general practitioners and practice nurses from four rural and urban areas served by 1 hospital-based genetics unit (29 participated in a genetic education outreach program and 188 were the control group.)
· Age: Not reported
· Race/Ethnicity: Not reported
· Years of practice: Not reported / Quasi-experimental design / · Knowledge:
–Significantly increased from pre-test to post-test scores in the intervention (education) group for breast cancer risk categorization.
· Self-efficacy:
–Compared to the control group, the intervention group confidence was significantly increased in breast and bowel cancer risk assessment, family history collection, and low-risk patient reassurance.
Blaine et al., 2008 / Canada / · 93 family physicians at two large Canadian family medicine (continuing education) conferences
· Age: 60% < 44 years old
· Race/Ethnicity: Not reported
· Years of practice: 10 years or more (57%) / Pre/post design / · Knowledge:
–Perceived increases in understanding of genetic testing (post-test).
· Attitudes:
–From pre/post-test analysis, significantly positive attitudes toward: 1) the importance of “preparing a patient in advance for what to expect at a genetic appointment,” 2) “the purpose of a referral to genetics is to obtain genetic testing,” and 3) “the genetic counselor will decide whether or not the patient undergoes genetic testing.”
· Intention:
–Increased intention to take thorough family histories among participants.
· Self-efficacy:
–Perceived increase in confidence in genetics referral (post-test).
· Program assessment
–Positive experience for most participants, and nearly all would recommend it to their colleagues.
Masny et al., 2008 / United States / · 41 nurses, who intended to provide/actually provided cancer risk assessments at the Fox Chase Cancer Center, attended a nursing training program in familial cancer risk counseling.
· Age: Not reported
· Race/Ethnicity: Not reported
· Years of practice: cancer risk assessment experience < 1 year: 70%;
cancer risk counselling experience: 2 months-5 years / · Pre/post design with six-month follow-ups (course evaluation) and a post-course interview (mentorship evaluation) / · Self-efficacy:
–Significant improvements in all familial cancer risk assessments and counseling skills from baseline to six months after the program.
· Comfort level:
–Improved comfort level in consulting cases with genetic health professionals.
· Practice behavior:
–Increased numbers of nurses who had consulted cases with genetic nurses and counselors from baseline, three-month, and six-month post-intervention data.
· Program assessment:
–Positive comments for the mentorship, but there were differences in experiences regarding mentorship between nurses who had less than one year of cancer risk assessment/counseling experience and those with more than one year of experience.
Carroll et al., 2009 / Canada / · 29 primary care providers who attended a full-day workshop. Program evaluation was based on 21 attendees who completed baseline and follow-up questionnaires (14 family physicians, 6 nurses/nurse practitioners, and one other).
· Age: Mean = 46 years old for 21 attendees
· Race/Ethnicity: Not reported
· Years of practice: 10-19 years (62%), > 20 years (29%)
/ Pre/post design with a 6-month follow-up / · Knowledge:
–Significant increase in adult-onset genetic disorders (self-rated knowledge) and colorectal cancer genetic knowledge (objective knowledge test) (pre-test and follow-up data comparison).
· Attitudes:
–Significant increase in agreements regarding the statement “genetic testing is beneficial in the management of adult-onset genetic diseases” (pre-test and follow-up data comparison).
· Intention:
–Intention to improve family history taking (71%).
· Self-efficacy:
–Significantly improved in confidence in clinical practice related to adult-onset genetic disorders and several specific tasks related to genetic risk assessment, genetic testing, and counseling (pre-test and follow-up data comparison).
–Significantly improved in confidence in acting as a resource person in adult-onset genetic disorders for their colleagues. (Pre-test and follow-up data comparison)
· Program assessment:
–Workshop rated as effective and relevant to practice by most participants.
Laberge et al., 2009 / United States / · 79 primary care physicians (e.g., family physicians, pediatricians, internists, obstetricians, gynecologists, and internal medicine specialists) and 21 genetic professionals (i.e., clinical geneticists and genetic counselors) from 20 teaching medical universities (evaluation data were based on 19 universities)
· Age: Not reported
· Race/Ethnicity: Not reported
· Years of practice: Not reported / One-shot case study/descriptive cross-sectional (follow-up evaluation after three years of completing the training) / · Practice behavior:
–86% of primary care physician participants reported more clinical genetic practice.
· Program assessment:
–Overall positive comments from both primary care physicians and genetic professional participants regarding the program, and they would recommend it to their colleagues. However, participants identified several challenges in real practice.