Exploring perceptions of genetic counseling student-run free clinics as an innovative service delivery model to increase access to genetic counseling services.
accessibility
genetic counseling
genetics services
service delivery models
student‐run free clinics
underrepresented populations
Journal
Journal of genetic counseling
ISSN: 1573-3599
Titre abrégé: J Genet Couns
Pays: United States
ID NLM: 9206865
Informations de publication
Date de publication:
24 Sep 2024
24 Sep 2024
Historique:
revised:
24
05
2024
received:
16
11
2023
accepted:
23
08
2024
medline:
25
9
2024
pubmed:
25
9
2024
entrez:
25
9
2024
Statut:
aheadofprint
Résumé
Underrepresented groups lack access to genetics services, heightening health disparities among those who benefit from advancements in precision medicine. An innovative approach to addressing this gap in care and increasing health equity in the context of genetic counseling is student-run free clinics (SRFCs). While only one recently established SRFC for genetic counseling is reported in the literature, SRFCs have a long-standing presence in other health professional schools, such as nursing, pharmacy and physical therapy, and research supports the benefits for patients and students. This qualitative study aims to explore the perspectives of certified genetic counselors (CGCs) and genetic counseling students (GC students) regarding SRFCs as an innovative service delivery model to increase access to genetic counseling services. Semi-structured Zoom interviews were conducted with 10 CGCs and 10 GC students across the United States. Participants were asked open-ended questions about how SRFCs could meet needs of the field, potential challenges in creating and maintaining these clinics, and anticipated outcomes. Through abductive thematic analysis of interview transcripts, three main themes were identified: (1) SRFCs can be mutually beneficial as alignment with profession goals potentially leads to positive outcomes for patients and students; (2) student scope of duties will vary depending on student ability corresponding with their training timeline and level of required supervision; and (3) successful SRFC implementation and sustainability will require thoughtful planning regarding collaboration, infrastructure support, clinic operations, visibility, and protections for vulnerable groups. Participants recognized SRFCs' potential to reduce health disparities by expanding access to genetic counseling for uninsured and underinsured populations. Implementing SRFCs could enhance the quality of GC student training, providing opportunities to apply skills and gain experience working with diverse patient populations. A key subtheme was the need to foster support from the CGC community in transitioning from a traditional supervision model. This research provides a baseline framework from which to further develop and implement SRFCs for genetic counseling.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : David Geffen School of Medicine, University of California, Los Angeles
Informations de copyright
© 2024 The Author(s). Journal of Genetic Counseling published by Wiley Periodicals LLC on behalf of National Society of Genetic Counselors.
Références
Accreditation Council for Genetic Counseling. (2023). Standards of accreditation for graduate programs in genetic counseling. Retrieved October 11, 2023, from https://www.gceducation.org/forms‐resources/
Arenas, D. J., Noche, R., Thomas, A., Hallak, D., & Raman, S. (2019). Systematic review of patient‐centered needs assessments performed by free health clinics. Journal of Student‐Run Clinics, 5(1), 8–10. https://doi.org/10.59586/jsrc.v5i1.79
Dedoose Version 9.0.85. (2023). Cloud application for managing, analyzing, and presenting qualitative and mixed method research data. SocioCultural Research Consultants, LLC. www.dedoose.com
Dhami, A., Rennebohm, M., & Bienz, D. (2019). 24 years of student‐run free clinics: A review of the community health advancement program (CHAP) dermatology clinic and challenges faced. Journal of Student‐Run Clinics, 5(1), 3–5. https://doi.org/10.59586/jsrc.v5i1.98
Dutta, R., Shearer, E., Garcia, L., Liu, H., Swee, J., Ku, S., Lai, C., Lin, S., Montacute, T., & Charon, M. (2021). Increasing patient activation at a student‐run free clinic: Effectiveness of a health education intervention. Journal of Student‐Run Clinics, 7(1), 1–8. https://doi.org/10.59586/jsrc.v7i1.210
Henry J. Kaiser Family Foundation. (2013). Health coverage by race and ethnicity: The potential impact of the affordable care act. The Henry J. Kaiser Family Foundation. Retrieved May 2, 2024, from https://www.kff.org/racial‐equity‐and‐health‐policy/issue‐brief/health‐coverage‐by‐race‐and‐ethnicity‐the‐potential‐impact‐of‐the‐affordable‐care‐act/
Hu, T., Cox, K. A., & Nyhof‐Young, J. (2018). Investigating student perceptions at an interprofessional student‐run free clinic serving marginalised populations. Journal of Interprofessional Care, 32(1), 75–79. https://doi.org/10.1080/13561820.2017.1363724
Jooma, S., Hahn, M. J., Hindorff, L. A., & Bonham, V. L. (2019). Defining and achieving health equity in genomic medicine. Ethnicity and Disease, 29, 173–178. https://doi.org/10.18865/ed.29.S1.173
Jordano, J. O., Gallion, T., Cevan, C., Carew, B., Lloyd, M. C., Weaver, E. O., Miller, R. F., & Dudek, M. (2023). How the other half screens: A model for partnerships between student‐run free clinics and genetic counseling programs to address disparities in hereditary cancer evaluation. Journal of Genetic Counseling, 1–9. https://doi.org/10.1002/jgc4.1835
Khalil, S., Hatch, L., Price, C. R., Palakurty, S. H., Simoneit, E., Radisic, A., Pargas, A., Shetty, I., Lyman, M., Couchot, P., Roetzheim, R., Guerra, L., & Gonzalez, E. (2020). Addressing breast cancer screening disparities among uninsured and insured patients: A student‐run free clinic initiative. Journal of Community Health, 45, 501–505. https://doi.org/10.1007/s10900‐019‐00767‐x
Landis, J. R., & Koch, G. G. (1977). The measurement of observer agreement for categorical data. Biometrics, 33(1), 159–174. https://doi.org/10.2307/2529310
Liberman, K. M., Meah, Y. S., Chow, A., Tornheim, J., Rolon, O., & Thomas, D. C. (2011). Quality of mental health care at a student‐run clinic: Care for the uninsured exceeds that of publicly and privately insured populations. Journal of Community Health, 36, 733–740. https://doi.org/10.1007/s10900‐011‐9367‐5
Madlensky, L., Trepanier, A. M., Cragun, D., Lerner, B., Shannon, K. M., & Zierhut, H. (2017). A rapid systematic review of outcomes studies in genetic counseling. Journal of Genetic Counseling, 26(3), 361–378. https://doi.org/10.1007/s10897‐017‐0067‐x
NSGC Professional Status Survey. (2021). Executive Summary. Retrieved October 11, 2023, from https://www.nsgc.org/Portals/0/Executive%20Summary%202021%20FINAL%2005‐03‐21.pdf
Pirzadeh‐Miller, S., Robinson, L. S., Read, P., & Ross, T. S. (2017). Genetic counseling assistants: An integral piece of the evolving genetic counseling service delivery model. Journal of Genetic Counseling, 26(4), 716–727. https://doi.org/10.1007/s10897‐016‐0039‐6
Raspa, M., Moultrie, R., Toth, D., & Haque, S. N. (2021). Barriers and facilitators to genetic service delivery models: Scoping review. Interactive Journal of Medical Research, 1, e23523. https://doi.org/10.2196/23523
Rebholz, C. M., Macomber, M. W., Althoff, M. D., Garstka, M., Pogribny, A., Rosencrans, A., Selzer, S., & Springgate, B. (2013). Integrated models of education and service involving community‐based health care for underserved populations: Tulane student‐run free clinics. Southern Medical Journal, 106(3), 217–223.
Reeve, C., Woolley, T., Ross, S. J., Mohammadi, L., Halili, S. B., Jr., Cristobal, F., Siega‐Sur, J. L., & Neusy, A. J. (2017). The impact of socially‐accountable health professional education: A systematic review of the literature. Medical Teacher, 39(1), 67–73. https://doi.org/10.1080/0142159X.2016.1231914
Ricker, C., Lagos, V., Feldman, N., Hiyama, S., Fuentes, S., Kumar, V., Gonzalez, K., Palomares, M., Blazer, K., Lowstuter, K., MacDonald, D., & Weitzel, J. (2006). If we build it… will they come?–establishing a cancer genetics services clinic for an underserved predominantly Latina cohort. Journal of Genetic Counseling, 15(6), 505–514. https://doi.org/10.1007/s10897‐006‐9052‐5
Schutte, T., Tichelaar, J., Dekker, R. S., Thijs, A., De Vries, T. P., Kusurkar, R. A., Richir, M. C., & Van Agtmael, M. A. (2017). Motivation and competence of participants in a learner‐centered student‐run clinic: An exploratory pilot study. BMC Medical Education, 17, 23. https://doi.org/10.1186/s12909‐017‐0856‐9
Schutte, T., Tichelaar, J., Dekker, R. S., van Agtmael, M. A., de Vries, T. P., & Richir, M. C. (2015). Learning in student‐run clinics: A systematic review. Medical Education, 49(3), 249–263. https://doi.org/10.1111/medu.12625
Sheu, L. C., Zheng, P., Coelho, A. D., Lin, L. D., O'Sullivan, P. S., O'Brien, B. C., Yu, A. Y., & Lai, C. J. (2011). Learning through service: Student perceptions on volunteering at interprofessional hepatitis B student‐run clinics. Journal of cancer education, 26, 228–233. https://doi.org/10.1007/s13187‐010‐0142‐6
Slomp, C., Morris, E., GenCOUNSEL Study, Price, M., Elliott, A. M., & Austin, J. (2022). The stepwise process of integrating a genetic counsellor into primary care. European Journal of Human Genetics, 30, 772–781. https://doi.org/10.1038/s41431‐022‐01040‐x
Smith, C. E., Fullerton, S. M., Dookeran, K. A., Hampel, H., Tin, A., Maruthur, N. M., Schisler, J. C., Henderson, J. A., Tucker, K. L., & Ordovás, J. M. (2016). Using genetic technologies to reduce, rather than widen, health disparities. Health Affairs, 35, 1367–1373. https://doi.org/10.1377/hlthaff.2015.1476
Smith, S., Thomas, R., Cruz, M., Griggs, R., Moscato, B., & Ferrara, A. (2014). Presence and characteristics of student‐run free clinics in medical schools. JAMA, 312(22), 2407–2410. https://doi.org/10.1001/jama.2014.16066
Society of Student Run Free Clinics. (2023). What is a student‐run free clinic? [Internet]. Society of Student Run Free Clinics. Retrieved October 11, 2023, from https://www.studentrunfreeclinics.org/
Stoll, K., Kubendran, S., & Cohen, S. A. (2018). The past, present and future of service delivery in genetic counseling: Keeping up in the era of precision medicine. American Journal of Medical Genetics Part C: Seminars in Medical Genetics, 178(1), 24–37. https://doi.org/10.1002/ajmg.c.31602
Suen, J., Attrill, S., Thomas, J. M., Smale, M., Delaney, C. L., & Miller, M. D. (2020). Effect of student‐led health interventions on patient outcomes for those with cardiovascular disease or cardiovascular disease risk factors: A systematic review. BMC Cardiovascular Disorders, 20, 332. https://doi.org/10.1186/s12872‐020‐01602‐1
Terry, A. B., Wylie, A., Raspa, M., Vogel, B., Sanghavi, K., Djurdjinovic, L., Caggana, M., & Bodurtha, J. (2019). Clinical models of telehealth in genetics: A regional telegenetics landscape. Journal of Genetic Counseling, 28(3), 673–691. https://doi.org/10.1002/jgc4.1088
Thompson, J. (2022). A guide to abductive thematic analysis. The Qualitative Report, 27(5), 1410–1421. https://doi.org/10.46743/2160‐3715/2022.5340
Walker, A. P. (2009). The practice of genetic counseling. In W. R. Uhlmann, J. L. Schuette, & B. M. Yashar (Eds.), A guide to genetic counseling (2nd ed., pp. 8–9). Wiley‐Blackwell.
Wise, H. H., Frost, J. S., Resnik, C., Davis, B. P., & Iglarsh, A. Z. (2015). Interprofessional education: An exploration in physical therapist education. Journal of Physical Therapy Education, 29(2), 72–83.
Woodson, A. H., Profato, J. L., Rizvi, S. H., Elsayegh, N., Rieber, A. G., & Arun, B. K. (2015). Service delivery model and experiences in a cancer genetics clinic for an underserved population. Journal of Health Care for the Poor and Underserved, 26, 784–791. https://doi.org/10.1353/hpu.2015.0090
Xiao, S. Y., Major, C. K., O'Connell, K. A., Lee, D., Lin, C., Sarino, E., & Chen, K. (2023). Breast and cervical cancer screening rates in student‐run free clinics: A systematic review. International Journal of Gynecology and Obstetrics, 162(2), 395–408. https://doi.org/10.1002/ijgo.14675
Zhou, C., Fruitman, K., Szwed, S., Wickersham, M., Spellun, J., & Zonana, J. (2022). Weill Cornell medicine wellness Qlinic: Adapting the student‐run clinic model to expand mental health services and medical education. Community Mental Health Journal, 58(7), 1244–1251. https://doi.org/10.1007/s10597‐022‐00943‐9