Roll out and influence of an educational program: Talking about risk, uncertainties of testing in genetics (TRUSTING).
Authors: Valerie A. Jenkins, Ruth Habibi, Virginia Hall, Pauline Leonard, Annaliese Lawn, Jay Naik, Rachel Papps-Williams, Lesley Fallowfield
Journal: Journal of Clinical Oncology (2024)

9025 Background: Family history clinics face significant capacity issues making calls for genetic testing of all breast cancer (BC) patients problematic. Mainstreaming of services by health care professionals (HCPs) is needed but many lack confidence and familiarity with genetic counseling. Following successful development and evaluation of the TRUSTING educational program (Fallowfield et al. BJC 2022), facilitators were trained to roll out workshops for BC HCPs. Here we report the workshops’ effect on participants’ knowledge, skills, and self-confidence and influence on mainstreaming. Methods: 1 surgeon, 3 oncologists, 1 nurse specialist facilitated the 8-hr program in pairs. Workshop content included didactic components to enhance knowledge and various exercises to promote self-awareness about individual participants’ tolerance to uncertainty and risk. Groups discussed 6 filmed scenarios showing interactions between surgeons and geneticists with the proband (triple negative BC and BRCA2 pathogenic gene alteration), her sister (BRCA2 +) and their anxious cousin (BRCA2 -). Pre-workshop, participants completed: - 1) an 18-item multiple choice knowledge questionnaire about gene testing in breast cancer 2) a 9-item questionnaire exploring self-confidence when discussing/advising patients about different aspects of BRCA testing, results, and treatments and 3) an Intolerance to Uncertainty Scale. Knowledge and self-confidence together with general feedback questions about overall satisfaction with facilitators and the event were assessed post workshop. Follow-up questionnaires sent 3-12 mths later examined the impact TRUSTING workshops had made on participants’ own practice and implementation of mainstreaming in their clinic. Results: 120 participants (61 surgeons; 41 nurses; 9 oncologists; 9 other) attended 12 UK workshops. There were improvements post workshop in knowledge (mean change = 6.57; 95% CI 5.97 to 7.16; p&lt;0.001) and self-confidence (mean change = 2.64; 95% CI 2.33 to 2.95; p&lt;0.001). Feedback about the facilitators’ approach was uniformly high (mean range 9.65 to 9.90 /10). Most found workshops useful, enjoyable, and informative; 98% would definitively recommend them to colleagues. Follow up data revealed that attendance significantly impacted individuals’ own practice with 59% reporting it had improved their discussions about genetic testing with patients. When asked about mainstreaming more generally 81% reported it as “OK” or “working very well”, others (16%) that it had not yet started or (3%) that it was problematic. Conclusions: Discussing the implications of pathogenic gene alterations on patients’ treatment and risk-reducing interventions is complex when patients are already coming to terms with a BC diagnosis. The TRUSTING educational program is an effective means of helping HCPs now involved in the mainstreaming of genetic testing.