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Hunt Brendish K, Patel D, Yu K, Alexander CK, Lemons J, Gunter A, Carmany EP. Genetic counseling clinical documentation: Practice Resource of the National Society of Genetic Counselors. J Genet Couns 2021; 30:1336-1353. [PMID: 34390070 DOI: 10.1002/jgc4.1491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 07/08/2020] [Accepted: 07/17/2021] [Indexed: 11/08/2022]
Abstract
Clinical documentation is an important extension of a genetic counseling encounter. The traditional types of clinical documentation include the clinical visit note (including follow-up visit note), letter to the referring physician, letter to the patient, and result summary to the patient and referring physician. Increasing patient volumes, new genetic counseling service delivery models, transition to electronic medical records (EMR), new specialty clinics in genetics, and advances in genetic testing technologies challenge the practice of writing multiple types of clinical documents. This practice resource (PR) seeks to provide best practices for U.S.-based genetic counselors to write efficient and comprehensive clinical documentation using a hybrid clinical document designed to facilitate communication between individual providers, providers, and patients/families, and providers and payers. The content of the hybrid clinical documentation will vary by genetic specialty but may include a summary of genetic services evaluation, genetic testing options and eligibility information, genetic test results, potential risks for genetic conditions, implications for family members, and medical management recommendations. An outline of a general hybrid document along with examples of hybrid clinic notes for three types of genetic counseling specialties is included in this document.
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Affiliation(s)
| | - Devanshi Patel
- Center for Cancer Risk Assessment, Mass General Hospital, Boston, MA, USA
| | - Kristen Yu
- Neaman Center for Personalized Medicine, NorthShore University HealthSystem, Evanston, IL, USA
| | | | - Jennifer Lemons
- Department of Pediatrics, The University of Texas Health Science, Houston, TX, USA
| | | | - Erin P Carmany
- Wayne State University School of Medicine, Detroit, MI, USA
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Russell C, Sandu V, Moroz I, Tran C, Keely E, Liddy C. Key Components of Traditional Consultation Letters and Their Relevance to Electronic Consultation Replies: A Systematic Review. Telemed J E Health 2020; 26:689-699. [DOI: 10.1089/tmj.2019.0161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Christopher Russell
- Department of Family Medicine, McMaster University, Hamilton, Canada
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Victor Sandu
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Isabella Moroz
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Canada
| | | | - Erin Keely
- Department of Medicine, University of Ottawa, Ottawa, Canada
- Ontario eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, Canada
| | - Clare Liddy
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Canada
- Ontario eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Canada
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Rash AH, Sheldon R, Donald M, Eronmwon C, Kuriachan VP. Valued Components of a Consultant Letter from Referring Physicians' Perspective: a Systematic Literature Synthesis. J Gen Intern Med 2018; 33:948-954. [PMID: 29508258 PMCID: PMC5975156 DOI: 10.1007/s11606-018-4356-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 01/10/2018] [Accepted: 02/05/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Effective communication between the consultants and physicians form an integral foundation of effective and expert patient care. A broad review of the literature has not been undertaken to determine the components of a consultant's letter of most value to the referring physician. We aimed to identify the components of a consultant's letter preferred by referring physicians. METHODS We searched Embase and MEDLINE (OVID) Medicine (EBM) Reviews and Cochrane Database of Systematic Reviews for English articles with no restriction on initial date to January 6, 2017. Articles containing letters from specialists to referring physicians regarding outpatient assessments with either an observational or experimental design were included. Studies were excluded if they pertained to communications from referring physicians to consultant specialists, or pertained to allied health professionals, inpatient documents, or opinion articles. We enumerated the frequencies with which three common themes were addressed, and the positive or negative nature of the comments. The three themes were the structure of consultant letters, their contents, and whether referring physicians and consultants shared a common opinion about the items. RESULTS Eighteen articles were included in our synthesis. In 11 reports, 91% of respondents preferred structured formats. Other preferred structural features were problem lists and brevity (four reports each). The most preferred contents were oriented to insight: diagnosis, prognosis, and management plan (16/21 mentions in the top tertile). Data items such as history, physical examination, and medication lists were less important (1/23 mentions in the top tertile). Reports varied as to whether referring physicians and consultants shared common opinions about letter features. CONCLUSIONS Referring physicians prefer brief, structured letters from consultants that feature diagnostic and prognostic opinions and management plans over unstructured letters that emphasize data elements such as detailed histories and medication lists. Whether these features improve outcomes is unknown.
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Affiliation(s)
- Arjun H Rash
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Robert Sheldon
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada.
| | - Maoliosa Donald
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Cindy Eronmwon
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Vikas P Kuriachan
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
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Gagliardi AR, Dobrow MJ, Wright FC. How can we improve cancer care? A review of interprofessional collaboration models and their use in clinical management. Surg Oncol 2011; 20:146-54. [PMID: 21763127 DOI: 10.1016/j.suronc.2011.06.004] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Multimodal cancer care requires collaboration among different professionals in various settings. Practice guidelines provide little direction on how this can best be achieved. Research shows that collaborative cancer management is limited, and challenged by numerous issues. The purpose of this research was to describe conceptual models of collaboration, and analyze how they have been applied in the clinical management of cancer patients. METHODS A review of the literature was performed using a two-phase meta-narrative approach. The first phase involved searching for conceptual models of collaboration. Their components and limitations were summarized. The second phase involved targeted searching for empirical research on evaluation of these concepts in the clinical management of cancer patients. Data on study objective, design, and findings were tabulated, and then summarized according to collaborative model and phase of clinical care to identify topics warranting further research. RESULTS Conceptual models for teamwork, interprofessional collaboration, integrated care delivery, interorganizational collaboration, continuity of care, and case management were described. All concepts involve two or more health care professionals that share patient care goals and interact on a continuum from consultative to integrative, varying according to extent and nature of interaction, degree to which decision making is shared, and the scope of patient management (medical versus holistic). Determinants of positive objective and subjective patient, team and organizational outcomes common across models included system or organizational support, team structure and traits, and team processes. Twenty-two studies conducted in ten countries examining these concepts for cancer care were identified. Two were based on an explicit model of collaboration. Many health professionals function through parallel or consultative models of care and are not well integrated. Few interventions or strategies have been applied to promote models that support collaboration. CONCLUSIONS Ongoing development, implementation and evaluation of collaborative cancer management, in the context of both practice and research, would benefit from systematic planning and operationalization. Such an approach is likely to improve patient, professional and organizational outcomes, and contribute to a collective understanding of collaborative cancer care.
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Affiliation(s)
- Anna R Gagliardi
- Toronto General Research Institute, University Health Network, Toronto, Ontario M5G2C4, Canada.
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Affiliation(s)
- John A Zic
- Vanderbilt University School of Medicine, Nashville, Tennessee 37232-5227, USA.
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Gagliardi AR, Wright FC, Davis D, McLeod RS, Urbach DR. Challenges in multidisciplinary cancer care among general surgeons in Canada. BMC Med Inform Decis Mak 2008; 8:59. [PMID: 19102761 PMCID: PMC2631026 DOI: 10.1186/1472-6947-8-59] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2008] [Accepted: 12/22/2008] [Indexed: 12/04/2022] Open
Abstract
Background While many factors can influence the way that cancer care is delivered, including the way that evidence is packaged and disseminated, little research has evaluated how health care professionals who manage cancer patients seek and use this information to identify whether and how this could be supported. Through interviews we identified that general surgeons experience challenges in coordinating care for complex cancer patients whose management is not easily addressed by guidelines, and conducted a population-based survey of general surgeon information needs and information seeking practices to extend these findings. Methods General surgeons with privileges at acute care hospitals in Ontario, Canada were mailed a questionnaire to solicit information needs (task, importance), information seeking (source, frequency of and reasons for use), key challenges and suggested solutions. Non-responders received up to three reminder packages. Significant differences among sub-groups (age, setting) were examined statistically (Kruskal Wallis, Mann Whitney, Chi Square). Standard qualitative methods were used to thematically analyze open-ended responses. Results The response rate was 44.2% (170/385) representing all 14 health regions. System resource constraints (60.4%), comorbidities (56.4%) and physiologic factors (51.8%) were top-ranked issues creating information needs. Local surgical colleagues (84.6%), other local colleagues (82.2%) and the Internet (81.1%) were top-ranked sources of information, primarily due to familiarity and speed of access. No resources were considered to be highly applicable to patient care. Challenges were related to limitations in diagnostics and staging, operative resources, and systems to support multidisciplinary care, together accounting for 76.0% of all reported issues. Findings did not differ significantly by surgeon age or setting of care. Conclusion General surgeons appear to use a wide range of information resources but they may not address the complex needs of many cancer patients. Decision-making is challenged by informational and logistical issues related to the coordination of multidisciplinary care. This suggests that limitations in system capacity may, in part, contribute to variable guideline compliance. Further research is required to evaluate the appropriateness of information seeking, and both concurrent and consecutive mechanisms by which to achieve multidisciplinary care.
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Waring DT, Harrison JE. Reply letters following orthodontic consultations: an audit of Merseyside general dental practitioners' satisfaction. PRIMARY DENTAL CARE : JOURNAL OF THE FACULTY OF GENERAL DENTAL PRACTITIONERS (UK) 2007; 14:53-8. [PMID: 17462137 DOI: 10.1308/135576107780556789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To assess the opinions of general dental practitioners (GDPs) working within the National Health Ser vice (NHS) in Merseyside regarding the length, format and appropriateness of consultant orthodontists' letters sent in reply to referral letters. MAIN OUTCOME MEASURES These were GDPs' satisfaction with the length, format and content of the reply letters; GDPs' preferences for the information deemed necessary in such letters; GDPs' awareness of the status of their patients and the actions they were requested to undertake. METHOD After piloting, questionnaires were mailed to 330 participating GDPs between August and October 2004. RESULTS Two hundred and fifty-one (76%) questionnaires were returned. With one exception, the length of consultants' letters was thought to be adequate. Of the responding GDPs 82% stated a preference for summaries of the diagnosis and treatment plan to be presented in a list format rather than as free text. Aspects of the treatment plan were thought to be more important than the information about the examination. Following receipt of the reply letter only 71% of GDPs were aware of what was happening to their patients and 75% knew what actions they were to undertake. CONCLUSIONS This audit provides evidence that GDPs consider that a significant portion of the information in consultants' reply letters is not needed. Relevant information may be poorly communicated.
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Affiliation(s)
- David T Waring
- Department of Orthodontics, University Dental Hospital of Manchester, Manchester, UK.
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Abstract
This is the second of two articles that explore the general practitioner (GP)-specialist relationship. In this article, we explore the nature of the referral process, beginning with referrals frequently made by GPs in Australia and reasons for referral to specialists. In Australia, GPs commonly refer patients to specialists, particularly orthopaedic surgeons, ophthalmologists, surgeons and gynaecologists for a variety of reasons, including diagnosis or investigation, treatment and reassurance (reassurance for themselves as well as reassurance for the patient). GPs will choose a specialist after considering a variety of factors, such as the specialist's medical skill, their previous experience with the specialist, the quality of communication between them, office location and patient preferences. The referral is generally made by telephone or by letter, the latter of which is known to vary significantly in content and quality. The specialist, GP and patient expectations of the referral and the consultation process are also described. Specialists expect the GP to provide information about the problem to be addressed and adequate patient history, GPs expect a clear response regarding diagnosis and management as well as justification for the course of action, and patients expect clear communication and explanation of the diagnosis, treatment and follow-up requirements. When these expectations remain unmet, GPs, specialists and patients end up dissatisfied with the referral process.
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Affiliation(s)
- L Piterman
- Department of General Practice, School of Primary Health Care, Monash University, Melbourne, Victoria, Australia.
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Evans W. Bibliography. HEALTH COMMUNICATION 2005; 17:105-113. [PMID: 15590345 DOI: 10.1207/s15327027hc1701_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Affiliation(s)
- William Evans
- Institute for Communication and Information Research, University of Alabama, Tuscaloosa, USA
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