Guilford Genomic Medicine Initiative (GGMI)

• Evaluate effectiveness of family history collection and decision support for increasing appropriate referrals to genetic counselors for patients at risk of hereditary cancer syndromes [ Time Frame: 1 year ] [ Designated as safety issue: No ]
  change in appropriate referal to genetic counseling one year before using MeTree compared to one year after.
• Evaluate effectiveness of family history collection and decision support for increasing appropriate screening for breast, colon, and ovarian cancer [ Time Frame: 1 year ] [ Designated as safety issue: No ]
  Compare rate of appropriate screening for breast, colon, and ovarian cancer one year prior to using the family history decision support tool and one year after
• Evaluate effectiveness of family history collection and decision support for appropriate risk-based management of thrombosis [ Time Frame: one year ] [ Designated as safety issue: No ]
  Evaluate rate of appropriate genetic counseling and/or genetic testing one year prior to using the family history collection and decision support tool and one year after

• Measure patient-related outcomes associated with using the MeTree tool [ Time Frame: Day 1 ] [ Designated as safety issue: No ]
  We assess satisfaction, comfort, anxiety, and preparedness associated with using the MeTree tool via survey immediately after completing the family history collection.
• Measure physician experience with the MeTree system [ Time Frame: 3 months ] [ Designated as safety issue: No ]
  Evaluate physicians' perceptions of satisfaction, the tool's impact on work load and its effectiveness via survey and informal interviews at 3 months.
• Implementation parameters for MeTree [ Time Frame: up to 2 years ] [ Designated as safety issue: No ]
  Part of the formative evaluation of the implementation process which includes other secondary measures as well as those related to impact on the clinic such as time to use the tool, questions asked while taking the tool, and resources and support that will be needed to implement the tool in a non-study environment

• Genomic medicine, using genetic information to improve health outcomes, is heralded as the answer to rising medical costs by focusing on prevention and tailored care. Despite its potential, little investigation has focused on how genomic medicine can be applied in health care. To be effective, it requires new ways to learn, deliver, and communicate medical information. It will also raise new ethical questions.
• The overall goal of Guilford Genomic Medicine Initiative (GGMI) is to identify the specific challenges in "re-structuring" an existing medical system to integrate genomic medicine, and create solutions that can be used by other medical systems, such as the extensive military medical care system. To accomplish this goal, GGMI includes the development of a large-scale genomic medicine education initiative targeted at the community, providers, and patients, and a clinical systems model to implement strategies to facilitate the integration of genomic medicine into several pilot practices.

The study takes place in two Primary care practices. Patient's that come in for well-visits are invited to participate in the study.

• Breast Cancer
• Ovarian Cancer
• Colon Cancer
• Thrombophilia

• Primary Care, Family Health History, Genetic Counseling,
• Primary Care, Family Health History

Inclusion Criteria:

• All patients scheduled for an upcoming well or new visit within the next 3 weeks with their primary care physician (at the two implementation clinics).

Exclusion Criteria:

• Non-english speaking
• not consentable
• adopted

• Duke University
• University of North Carolina, Greensboro