GENETICS AND COLORECTAL CANCER: A DEPARTMENT OF VETERANS AFFAIRS/NCHPEG COLLABORATION Holly L. Peay, MS CGC NCHPEG

The Product  A web-based continuing education product  Expected VA launch: November 09  Housed in the VA’s continuing education system and available to all VA healthcare providers  Available on the NCHPEG website

Purpose Provide VHA healthcare providers with the information and skills necessary to undertake genetic risk assessment for colorectal cancer, identify patients at increased risk, refer appropriate patients for genetic counseling and testing, and target screening and management to the patient’s risk status.

Learning Objectives Users should be able to:  take a targeted family and medical history that allows recognition of risk factors and red flags for CRC,  identify the goals and process of genetic counseling about risk for cancer,  recognize the indications for referral for genetic counseling and the offer of genetic testing for hereditary cancer syndromes,

Learning Objectives, con’t  identify the screening and management recommendations for patients at increased familial risk for CRC, and for patients at high risk for CRC and other cancers associated with hereditary cancer syndromes, and  describe the implications for relatives of patients with hereditary cancer syndromes.

Target Audiences Primary care providers; gastroenterology providers; and providers in oncology, surgery, and pathology Target providers include physicians, nurses, and physician assistants

Needs of VA Providers  Identify patients at increased familial risk and modify screening  Identify patients at risk for hereditary cancer syndromes and refer to genetics specialist  Very few genetics providers in the VA system  Difficulty in some VA centers providing outside referrals  Need to support providers who have to provide some genetic counseling/testing services themselves

Preferences of the Target Audience We expected that the target audience would desire a continuing education product that employs an interactive, case-based approach to learning.  End users requested:  Point-of-care materials provided off of the VA’s continuing education server  Limited use of cases  Flexibility in accessing content  Content integrated into the EMR

Resulting Product- A Compromise  Cont Ed Tutorial  3 learning modules Risk Assessment Genetic Testing Genetic Counseling  5 interactive case studies Clinical diagnosis Lynch At-risk Lynch FAP AFAP Moderate risk based on family history *Housed on the LMS  Genetics and CRC Toolbox  Fact sheets  Point-of-care tools  Web-based risk assessment algorithm  Resources * Housed off of the LMS

Take-Home Messages  Assess needs of target audience  Include the end user in early development  Provide flexibility in the development process to respond to users’ needs  Content needs  Delivery approach  Conduct a formative evaluation  Anticipate changes to preferred and most effective educational approaches

Next Steps  Finalize structure, format, content with VA web contractor  Implement content on VA LMS system  Revise content for NCHPEG website  Provide ancillary materials for medical students and other trainees  Plan and implement dissemination outside of the VA system  Consult with VA on project evaluation