The rise of genetic counselling in nursing

The nursing practice is fast changing as we learn more about gene-related diseases.

Within a patient’s genome lies crucial information about their health, risk of certain diseases, and drug response. If we could uncover these insights in a meaningful way, it could pave the way towards better disease diagnoses and truly personalised treatment.

This is why the field of genomics is fast growing all over the world, from the United Kingdom to Singapore. Here, the goal is to get ahead of various rare diseases and cancers by creating preventive treatments based on a patient’s genetic makeup.

There is an exciting opportunity for nurses to upskill to become ‘genetic counsellors’, particularly as they make up the largest segment of the global health workforce. In Hong Kong, early efforts to introduce genomics into the nursing practice are promising.

Decoding the secrets of genes

Genomic education in nursing is becoming increasingly important, as it helps nurses to understand if diseases such as cancer are gene-related or due to lifestyle factors, explains Susanna Lee, Associate Professor (Nursing Practice) at the LKS Faculty of Medicine at the University of Hong Kong. “After they are born, is there anything that can change or avoid it, or is this unavoidable?” she tells Hospital Insights Asia on the sidelines of Hospital Management Asia last year.

This new understanding shapes how nurses treat their patients, introducing medication and lifestyle interventions where necessary. “After the diagnosis, you should know how to deal with this,” Assoc Prof Lee continues.

She is particularly interested in conducting a study into the role of genetics in obesity. “If it is gene-related, after birth, is the patient ‘born to be fat’? But if the patient exercises and everything, can we reverse the condition a little bit, or a lot?” Assoc Prof Lee goes on to say.

In January 2019, the Hong Kong government announced the Hong Kong Genome Project, which would sequence the whole genomes of 20,000 people. It has set aside HK$682 million or US$87 million for this initiative, which aims to improve cancer treatment and diagnosis of rare diseases.

More precise treatment

But there is still more to be done to apply genomics at point of care. A paper that was published last year in International Nursing Review notes how “there are still many gaps in the translation of genomic medicine into clinical practice” in Hong Kong. There is also a shortage of nurses to contend with, the paper said.

To bridge this gap, the Chinese University of Hong Kong has introduced a two-year programme for genetic counsellors, according to the paper. Currently, it is designed to target obstetricians, paediatricians and laboratory professionals, in addition to nurses.

The Cancer Genetics Service at National Cancer Centre Singapore, for instance, has deployed genetic counsellors that play a big role in patient education, according Dr Joanne Ngeow, Head of the Cancer Genetics Service. These counsellors hold master’s degrees and cannot physically examine patients, but instead, help patients understand what genomics is, and support patient education in other ways. They can also advise where genetic testing is appropriate for a patient, and explain the test results to them.

“One issue with treating patients only after they have been diagnosed with cancer is that very often, it’s actually really difficult to achieve a cure,” Dr Ngeow said last year. Genomics helps clinicians and nurses become much more precise in treatment, she added.

Nurses as patient advocates

At the same time, nurses are evolving to become patient advocates as healthcare needs change. Many parts of Asia are rapidly ageing, and healthcare systems are struggling to fill the gaps in integrated care.

A senior citizen may see multiple doctors and providers for various chronic diseases, particularly with a shift to community care. Sometimes, crucial information may fall through the cracks, HKU’s Assoc Prof Lee says.

She believes that patient advocates can help elderly patients and their families navigate a complex healthcare system. In essence, nurses take on the role of case manager to help each patient with their individual care needs, she says.

“The nurse will be a very, very good advocate to be a coordinator, a facilitator, a referrer and link person so as to fill the service gap,” Assoc Prof Lee elaborates. “The role of nurses is expanding, and the proactive role is very important.”

As nurses take on more roles and responsibilities, training techniques are evolving too. Assoc Prof Lee leads interactive scenario-based courses, where trainee nurses learn critical thinking and reasoning skills – for instance, they work in groups to figure out how to stop medication errors from happening. “This type of interactive training or learning will be more effective, than to just tell them what to do,” Assoc Prof Lee adds.

The bottom line? Nurses are a necessary conduit between the patient and the healthcare provider. Armed with the right tools, knowledge and resources, they can be the key to better patient outcomes.