ASPO Abstracts
Is Navigation an Equalizer in Reducing Disparities in Receipt of Genetic Counseling for Underserved Women at Risk of BRCA1/2?
Category: Cancer Health Disparities
Conference Year: 2019
Abstract Body:
Purpose: Genetic counseling (GC) provides critical information (e.g. risk prediction) to women at-risk of BRCA1/2; yet racial/ethnic and socio-economic disparities persist with regard to uptake. This study examined patterns of GC uptake following a referral. Methods: We reviewed medical records from 2015-2017 for women who were referred to a genetic counselor for reasons related to hereditary breast cancer (e.g. breast cancer diagnosis before age 50, family history). Standard practice includes telephone navigation by a “New Patient Coordinator” following a referral. The coordinator works with the patient to schedule an appointment and sends the patient an appointment letter and a pre-appointment questionnaire that asks patients to list their medical/family histories and to state their goals for the appointment. Primary outcomes were: whether the woman made a GC appointment (yes/no) and if an appointment was kept (yes/no). Sociodemographic factors were age, race, employment status, marital status, and insurance status. Associations between sociodemographic factors and the outcomes were assessed using Chi-square, and logistic regression was used for the multivariable analysis. Results: A total of 510 women who were referred to GC. Over half were White (55.3%), not married (52.9%) and employed (53.1%). Most (83.8%) women made appointments. No significant associations were observed between sociodemographic factors and making an appointment. Of the 425 women who made appointments, most kept their appointment (62.8%). Insurance status (insurance vs. no insurance) (p=0.003), marital status (married vs. not married) (p=0.000), and work status (employed vs. not employed) (p=0.039) were all significantly related to keeping an appointment. In the multivariable logistic model, being, married (OR 2.119 (95% CI 1.341 to 3.347) p=0.001) and having insurance (OR 2.203 (95% CI 1.208 to 4.016) p=0.021) increased the likelihood of keeping an appointment. Conclusions: Racial disparities in GC uptake were not observed in this hospital-based sample. Navigators may play a critical role in reducing GC access disparities. Women who were not married/partnered may be a subgroup in need of support to obtain GC.
Keywords: Genetic CounselingDisparitiesNavigation