Alternative models of genetic counselling and testing for patients with ovarian cancer
| Model | Description | Impact |
| Opt-out genetics referral pathway | Unless their surgeon specifies otherwise, genetics referrals are processed automatically based on a list of newly diagnosed patients with ovarian cancer generated from the electronic health record. | Increases referral rates Decreases time from diagnosis to referral May result in overall increased wait-times |
| Genetics-mediated referrals | Genetic counsellors identify eligible patients and recommend genetics referrals. Can be done by attendance at oncology meetings or chart review. | Increases referral rates Requires added genetic counselling resources May result in overall increased wait-times |
| Embedding genetic counsellors into oncology clinics | Genetic counsellors are present in oncology clinics to identify eligible patients and coordinate genetic counselling during oncology visits. | Increases referral rates Coordinated counselling may reduce wait-times Requires added genetic counselling resources |
| Mainstreaming | Genetic testing ordered by the oncology team with support from clinical genetics. | Increases genetic testing rates Decreases wait-times Absence of extensive pre-test counselling |
| DNA-Direct | Genetic testing ordered remotely following genetics referral using an information sheet, pre-test video and blood collection kit. | May increase genetic testing rates Decreases wait-times Absence of extensive pre-test counselling |
| DNA BONus | Genetic testing ordered by the oncology team using a pre-test information sheet. | May increase genetic testing rates Decreases wait-times Absence of pre-test counselling |
| Reflexive tumour testing | Genetic testing is ordered reflexively on ovarian tumour tissue. | Rapid access to genetic information for treatment Minimise number of germline tests required Absence of pre-test counselling Concerns about patient consent |