Cancer Risk Assessment Counseling
The scope of genetic counseling practice has expanded over the past several years to address risk assessment and genetic testing for hereditary cancer predisposition. Cancer risk assessment counseling has emerged as a specialized practice that requires knowledge of genetics, oncology, and individual and family counseling skills that may be provided by health care providers with this interdisciplinary training.[25,26] Some centers providing cancer risk assessment services involve a multidisciplinary team, which may include a genetic counselor; a genetics advanced practice nurse; a medical geneticist or a physician, such as an oncologist, surgeon, or internist; and a mental health professional. The Cancer Genetics Services Directory provides a partial list of individuals involved in cancer risk assessment, genetic counseling, testing, and other related services and is available on the National Cancer Institute's Web site.
The need for advanced professional training in cancer genetics for genetics counselors, physicians, nurses, laboratory technicians, and others has been widely reported.[27,28,29,30,31] Despite these identified needs, the evidence indicates that competency in genetics and genomics remains limited across all health care disciplines, with the exception of genetic specialists. Deficits in the following have been identified: (1) knowledge about hereditary cancer syndromes  and risk-appropriate management strategies; (2) provision of genetic counseling services; (3) documentation and use of personal and family cancer history to identify and refer patients at increased risk of hereditary cancer syndromes;[35,36,37,38] and (4) knowledge about genetic nondiscrimination laws.[35,39] (Refer to the table on Health Professional Practice and Genetic Education Information in the PDQ Cancer Genetics Overview summary for more information.)
The National Coalition for Health Professional Education in Genetics has published and updated core competencies for all health professionals. Building on this work, individual health professions, such as nursing and physician assistants, have developed and published core competencies specific to their profession.[40,41] A number of other organizations have also published professional guidelines, scopes, and standards of practice.[42,43,44,45,46]
Traditionally, genetic counseling services have been delivered using individualized in-person appointments. However, other methodologies are being explored, including group sessions, telephone counseling, and telemedicine by videoconferencing.[47,48,49,50,51,52,53,54] Additionally, computer programs and Web sites designed to provide genetics education can be successful adjuncts to personal genetic counseling services in a computer-literate population.[55,56,57,58,59]