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The stepwise process of integrating a genetic counsellor into primary care

European Journal of Human Genetics volume 30, pages 772–781 (2022)Cite this article

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A Correction to this article was published on 07 March 2022

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Abstract

Genetic services have historically been housed in tertiary care, requiring referral, which can present access barriers. While integrating genetics into primary care could facilitate access, many primary care physicians lack genomics expertise. Integrating genetic counsellors (GCs) into primary care could theoretically address these issues, but little is known about how to do this effectively. To understand and describe the process of integrating a GC into a multidisciplinary primary care setting, we qualitatively explored the perceptions, attitudes and reactions of existing team members prior to, and after the introduction of a GC. Semi-structured interviews were conducted immediately prior to (T1), and 9 months after (T2), the GC joining the clinic. Interviews were recorded, transcribed verbatim and analyzed concurrently with data collection using interpretive description. Twenty-four interviews were conducted with 17 participants (13 at T1, 11 at T2). Participants described several distinct, progressive stages of interaction with the GC: Disinterest or Resistance, Pre-Collaboration, Initial Collaboration, and Effective Collaboration/Integration of the GC into the team. At each stage, specific needs had to be met in order to advance to the next stage of collaboration. A variety of barriers and facilitators attended movement between different stages of the model. The Stepwise Process of Integration Model describes the process through which primary care staff and clinicians integrate a GC into their practice. The insight provided by this model could be used to facilitate more effective integration of GCs into other primary care settings.

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Fig. 1: The Stepwise Process of Integration Model.
Fig. 2: Major barriers to participants’ progression through the Stepwise Process of Integration Model.

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Data availability

Data are available from the corresponding author on reasonable request.

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Acknowledgements

The authors would like to thank Patricia Birch for her assistance with ethics approval. The GenCOUNSEL Study is led by AME, JA, Bartha Maria Knoppers, and Larry D. Lynd with Project Manager Alivia Dey, and includes the following co-investigators: Shelin Adam, Nick Bansback, Patricia Birch, Lorne Clarke, Nick Dragojlovic, Jan Friedman, Deborah Lambert, Daryl Pullman, Alice Virani, Wyeth Wasserman, and Ma’n H. Zawati. JA was supported by the Canada Research Chairs program and BC Mental Health and Substance Use services. The authors offer gratitude to the Coast Salish Peoples, including the xʷməθkwəy̓əm (Musqueam), Skwxwú7mesh (Squamish), Səl̓ílwətaʔ/Selilwitulh (Tsleil-Waututh), lək̓ʷəŋən (Lekwungen)—Esquimalt and Songhees Nations, on whose traditional, unceded and ancestral territory we have the privilege of working.

Funding

GenCOUNSEL was funded through the Large Scale Applied Research Project (LSARP) Genome Canada competition with co-funding from: Canadian Institute for Health Research (CIHR), Genome BC, Genome Québec, Provincial Health Services Authority, BC Children’s Hospital Foundation and BC Women’s Hospital Foundation.

Author information

Authors and Affiliations

  1. Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada

    Caitlin Slomp, Emily Morris & Jehannine Austin

  2. Department of Family Practice, University of British Columbia, Vancouver, BC, Canada

    Morgan Price

  3. Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada

    Alison M. Elliott & Jehannine Austin

Authors
  1. Caitlin Slomp
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  2. Emily Morris
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  3. Morgan Price
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  4. Alison M. Elliott
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  5. Jehannine Austin
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Consortia

GenCOUNSEL Study

  • Bartha Maria Knoppers
  • , Larry D. Lynd
  • , Alivia Dey
  • , Shelin Adam
  • , Nick Bansback
  • , Patricia Birch
  • , Lorne Clarke
  • , Nick Dragojlovic
  • , Jan Friedman
  • , Deborah Lambert
  • , Daryl Pullman
  • , Alice Virani
  • , Wyeth Wasserman
  • , Ma’n H. Zawati
  • , Caitlin Slomp
  • , Emily Morris
  • , Morgan Price
  • , Alison M. Elliott
  •  & Jehannine Austin

Contributions

CS was responsible for developing study protocols, recruitment, data collection, data analysis, development of the theoretical model, and writing the manuscript. EM was responsible for study recruitment, data collection, data analysis, development of the theoretical model and critical review of the manuscript. MP was responsible for study design and critical review of the manuscript. AME was responsible for study design, modifications to the theoretical model and critical review of the manuscript. JA was responsible for study design, development of the theoretical model, and critical review of the manuscript.

Corresponding author

Correspondence to Jehannine Austin.

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Competing interests

MP works as a physician at the Cool Aid Community Health Centre.

Ethical approval

This study received harmonised ethical approval from the BC Children’s and Women’s Research Ethics Board (H18-03333) and Island Health (VIHA).

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Slomp, C., Morris, E., GenCOUNSEL Study. et al. The stepwise process of integrating a genetic counsellor into primary care. Eur J Hum Genet 30, 772–781 (2022). https://doi.org/10.1038/s41431-022-01040-x

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