When Wendy Brouwer set out to learn more about how genetics and cancer converge, she had no idea the uphill battle she would face.
“I really had to dig to find a course that would give me the level of information I needed to detect patients whose genetic profiles increased their risk for cancer,” says Brouwer, a women’s health nurse practitioner in the Breast Medical Oncology department.
She finally located a 14-week course at the City of Hope Cancer Center in Duarte, California, but had to wait two years for an available space.
“If I had this much trouble finding a class, then other nurses did, too. That’s when I realized that the entire nursing profession is starving for genetics education,” says Brouwer, who completed the course and is now among the less than 90 certified advanced genetic nurses in the United States.
Like most health care professionals, nurses are faced with a wealth of new information about the role of genetics in disease and health.
From the time scientists completed mapping all the genes in the human body 15 years ago, a flood of new genetic information and technology has been introduced. Nurses are required to understand and translate these concepts to patients, yet most have received little to no education about the subject.
“The average age of today’s registered nurse is 50. Genetics wasn’t formally introduced into nursing education until 2008, when most experienced nurses were at least 45 years old,” Brouwer explains. “So it’s easy to see why many have not been trained in the topic and may not feel comfortable incorporating genetics assessment and implications into a patient care plan.”
Closing the gap
To close this gap, Brouwer worked with genetic counselors to create a series of four, one-hour courses to teach MD Anderson nurses in Breast Medical Oncology about hereditary cancers. The Oncology Nursing Genetics Academy, as it is called, includes a basic genetics primer about how genetic mutations occur, are inherited and can lead to cancer. Nurses also learn how to:
- gather a patient’s family history and record that information in MD Anderson’s electronic health record.
- identify patients who need genetic counseling, educate them about what to expect, and teach them how to prepare for a genetic counseling appointment.
- recognize patients who should be referred to the high-risk breast clinic.
When classes were rolled out in a recent pilot program, the room was filled.
Nurses at all levels — registered nurses, advanced practice nurse practitioners, research nurses, nursing assistants, licensed vocational nurses, and even some physician assistants and social workers — attended.
During the classes, some attendees expressed a hesitancy to answer patients’ specific genetic questions, especially since direct-to-consumer genetic tests are leading more patients to ask for clarification and advice.
“We tell our nurses that their role is to ‘recognize and refer’ – recognize patients who are at high risk for cancer based on their personal or family histories, then refer them to genetic counselors,” Brouwer says.
Today, all registered nurses in Breast Medical Oncology have completed the four-class series. Results show a significant improvement in their knowledge level, and an increase in the number of patients referred to genetic counselors.
Bouwer hopes the program can be expanded to other departments and to MD Anderson’s campuses beyond the Texas Medical Center.
“Nurses are the largest frontline workforce in the medical field — MD Anderson’s main campus alone employs more than 3,000 oncology registered nurses,” she says. “We’re in an ideal position to obtain personal and family medical histories, and to inform physicians about patients who are at risk and need referrals to genetic counselors. With a little education, we can make a huge impact.”