Skilled cancer risk counselors and cancer prevention and control studies are critically needed to improve the efficacy and range of management options available to individuals identified to have a genetic cancer predisposition. Cancer risk assessment involves more steps and provider time than most other clinical services, and has emerged as a highly specialized discipline. Practitioner- level competence in cancer risk assessment is marked by advanced skills, including the ability to: generate expanded differential diagnoses;determine individualized cancer risk (genetic and/or empiric);provide tailored risk management recommendations;and identify potential research study eligibility. Most community-based cancer genetics practitioners do not have adequate skills or opportunity to participate in research. The composite of these skills is not yet fully addressed in the curricula of medical school, genetic counseling or nursing training programs. Once the exclusive domain of academic health centers, clinical cancer genetics services are increasingly being delivered in community settings. Consequently, a substantial number of potential clinical research subjects may not be realized. The NCI bypass budget for 2005 highlights the importance of cancer communications and strategies to address the clinical, behavioral and societal issues associated with cancer susceptibility (NIH Publication No. 03-5446). The document notes the importance of promoting networks, partnerships and coalitions to translate the results of research into clinical practice and public health benefit. However, to date there are no intensive training programs in clinical cancer genetics and research collaboration for community-based clinicians. Recently published outcomes from a pilot course demonstrated significant improvement in cancer genetics knowledge for participants (p>0.001), and a needs assessment survey demonstrated continued need for education in the target populations, and research collaboration interest and efforts by pilot course alumni suggested the feasibility of using a course to promote participation in research activities. Therefore, we propose to develop a multi-modal, interdisciplinary course to confer practitioner-level competence in cancer risk assessment, and skills to promote research participation in a community setting. The program will provide approximately 60 hours of prescribed didactic and interactive instruction, twelve months of continued practice development via web-conferencing and long-term access to a web board for asynchronous learning. The program design is novel, uses multiple synchronous and asynchronous teaching modalities to maximize learning, and is flexible to accommodate the needs of participants with varied training backgrounds and practice settings. The impact of the course on participant knowledge, skills, changes in practice, and research participation will be measured. Long-term objectives of the project are to increase community access to competent cancer genetics services, and to increase accrual of high-risk patients into research protocols. The curriculum and delivery design may serve as a model for dissemination to other cancer centers to help address NCI priorities such as augmentation of familial registries (e.g. Cooperative Family Studies)
