Organizacija in analiza obravnav genomskih informatorjev na Onkološkem inštitutu Ljubljana v letu 2023
Organisation and analysis of genomic counsellors' assessments at the Institute of Oncology Ljubljana in 2023
DOI:
https://doi.org/10.25670/oi2024-014onKeywords:
genetic testing, genetic counselling, genomic counsellor, fast track referrals, cancerAbstract
Izhodišče: V Sloveniji je od leta 2021 uveden nov profil v zdravstvu – genomski informator. Genomski informator/svetovalec na Onkološkem inštitutu Ljubljana (OIL) prevzema del genetskih posvetov, ki jih v sklopu triaže opredeli specialist klinične genetike. V veliki meri gre za prednostne napotitve bolnikov z rakom, pri katerih je genetski izvid pomemben za načrtovanje zdravljenja. Metode: Analizirali smo podatke o napotitvah na genetsko obravnavo v letu 2023 in genetskem testiranju bolnikov, ki so jih obravnavali genomski svetovalci. Podatke smo pridobili iz zbirke podatkov Oddelka za onkološko klinično genetiko OIL. Za pripravo analize smo uporabili deskriptivne statistične metode in bivariatne metode za analizo povezanosti spremenljivk. S pomočjo bivariatnih metod smo preučevali povezave med posameznimi spremenljivkami, kot so spol, starost in vrsta genetske obravnave, ter njihovo povezanost z rezultati genetskega testiranja, kar nam je omogočilo vpogled v morebitne vzorce ali odvisnosti med njimi. Rezultati: Leta 2023 so štirje genomski svetovalci od skupno 2200 opravljenih genetskih posvetov pred testiranjem, opravili 669 svetovanj, kar predstavlja 30,4 % vseh. Od 669 obravnavanih pacientov (118 moških in 551 žensk) se jih je 662 odločilo za genetsko testiranje. Glede na stopnjo nujnosti obravnave, ki jo je označil napotni zdravnik, je bilo največ obravnavanih pod prednostno, in sicer 323 (48 %). Genetski izvid smo pri prednostno napotenih v povprečju prejeli v 29 (± 13) dneh od datuma prvega posveta. Pri 14,5 % (96) testiranih pacientih je bila patogena/ verjetno patogena različica (PR/VPR) odkrita v vsaj enem od pregledanih genov. Največ PR/VPR je bilo odkritih v genih BRCA1/2 (57,3 %). Po pogostosti jim sledijo PR/VPR v genu ATM (14,6 %) in genu CHEK2 (10,4 %). Zaključek: Vpeljava diplomiranih medicinskih sester s specialnimi znanji na področju genomskega svetovanja se je izkazala kot učinkovita strategija za zagotavljanje pravočasne genetske obravnave. Medicinske sestre po dodatnem usposabljanju samostojno izvajajo prve genetske posvete, kar je prispevalo k skrajšanju čakalnih dob in hitrejši obravnavi pacientov. Z dodatnimi posveti smo razbremenili specialiste klinične genetike, kar je pripomoglo k hitrejši obravnavi pacientov, ki niso bili napoteni prednostno.
Abstract (Eng)
Introduction: In 2021, the role of genomic counsellor was introduced as a new profile in the Slovenian healthcare system, and likewise at the Institute of Oncology Ljubljana (IOL). In the triage process, clinical genetics specialists determine the number of genetic consultations performed by genomic counsellors, who usually provide counselling for patients who require genetic testing for treatment planning. Methods: We evaluated the data on referrals to genetic counselling and the genetic testing of patients referred to genomic counsellors in 2023. The data were obtained from the database of the Department of Clinical Cancer Genetics at OIL. Descriptive statistical methods and bivariate methods were used for analysing the correlation between variables. Results: In 2023, 2,200 pre-testing genetic counselling consultations were performed. Four genomic counsellors performed 30.4% (669/2.200) of all pre-test genetic counselling consultations. 662 out of 669 patients (i.e. 118 men and 551 women) opted for genetic testing. There were 323 (48%) urgent – fast–track listed patients. The test results of the fast–track listed group were received in 29 (±13) days after the first consultation. In 14.5% (96) of the patients tested a pathogenic/likely pathogenic variant (P/LPV) was identified. The most P/LPVs were found in BRCA1/2 genes (57.3%), followed by the ATM gene (14.6%) and CHEK2 gene (10.4%). Conclusion: Introducing a new profile, a registered nurse with special knowledge in genomic counselling, working as a genomic counsellor, is a successful method of ensuring timely patient care. The additional consultations have helped shorten the waiting times for genetic counselling performed by clinical genetics specialists and speed up the process of genetic treatment for patients.
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Copyright (c) 2024 Romana Krivec Matijašič, Tina Kerševan, Mateja Krajc

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