Table 2

Alternative models of genetic counselling and testing for patients with ovarian cancer

ModelDescriptionImpact
Opt-out genetics referral pathwayUnless 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 referralsGenetic 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 clinicsGenetic 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
MainstreamingGenetic 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-DirectGenetic 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 BONusGenetic 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 testingGenetic 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