Running Head: Genetic Counseling

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The Know Your Genes Foundation
Genetic Counseling as a First Choice
Cordia Frazier
HLTH 634-D01
May 11, 2014













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The Know Your Genes Foundation
Genetic Counseling as the First Option
Cordia Frazier
The Health Communication Program Intervention has been organized to facilitate
informed decision making for Ashkenazi Jewish women with a family history of breast and/or
ovarian cancer. Genetic counseling is a means to this facilitation. Genetic counselors take a non-
directive approach to counseling their clients.
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This means that they assist clients in determining
the best decisions from a personal perspective without guidance towards a decision.
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The
information shared by these counselors is tailored to that specific situation as opposed to a
predetermined set of facts.
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This selection and framing of tailored data influences decision
making by the clients.
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Problem/Need Statement:
The problem is that not enough women in our community with a family history of breast
and/or ovarian cancer know they are able to access genetic counseling services. These services
provide an understanding of the nature of breast and ovarian cancers, their risks, and prevention
and treatment procedures. Once pursued, the target audience will have an opportunity to undergo
genetic testing which is the final confirmation of genetic cancer-related mutations present.
Goal 1: To minimize a lack of awareness of genetic counseling
The objective for this goal is within the first month of the program, 80% of participants
will be able to identify the nature of breast and ovarian cancers, risks, and prevention and
treatment procedures, as measured by attended genetic counseling sessions.
Goal 2: To increase the proportion of women who receive genetic counseling
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The objective for this goal is by the end of the program, all participants will demonstrate
a positive outlook on cancer diagnosis, as measured by questionnaires provided after the use of
communication channels.
Goal 3: To maximize early detection of breast and ovarian cancer
The objective for this goal is by the end of the program, 75% of participants will execute
the steps to prevention procedures delaying breast and ovarian cancer, as measured by early
physician inspection.
Sponsoring agency/Contact person:
The Virginia Baptist Genetic Clinic under the Virginia Association of Genetic
Counseling is our sponsoring agency. The contact person is the Director of the Genetic Clinic.
Primary target audience:
Ashkenazi Jewish women in our community are the target audience. They are moderately
health conscious, and read health-related print material, follow daily health news broadcasts, and
attend informational meetings. These women are of Jewish descent from Germany, France and
Eastern Europe, and they practice either Judaism or Christianity. The target audience has all high
school graduates with some tertiary education experience, most work within the urban
community, and they live either in the urban community or in surrounding counties. These
women are between ages 18 and 40 years, have a family history of breast and/or ovarian cancer,
and suspect themselves or a family member carries a BRCA 1 or 2 mutation. Most of these
women are married and have children, and have a negative outlook on overcoming breast and
ovarian cancer.
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Primary target key strategies:
After the target audience hears, watches or experiences the communication, they will opt
to schedule an appointment with a genetic counselor in order to make decisions on genetic
testing, and possible treatment options if diagnosed with cancer. Due to the genetic nature of
breast and ovarian cancer for these women, our organization hopes that if they are diagnosed
there are more cases where cancer will be detected earlier. The barriers that exist are our
audience is not aware of the local genetic clinic in their area, and most only have one vehicle that
is used between multiple individuals in the household. One benefit experienced with the
intervention is finding out if they may be at risk developing an early-onset of breast or ovarian
cancer. The benefits outweigh the barriers because cancer will be detected earlier which brings
the expectation of longer healthier living. There will be multiple channels used in this
intervention, such as an established newsletter, radio, television, posters, brochures, and
seminars.
Secondary target audience:
The secondary target audience is healthcare professionals who serve the urban and
surrounding rural communities. They are information seekers and supporters of all cancer
awareness. They are professionals from different ethnic backgrounds, and appreciate family
structure. These professionals include physicians, nurses, public health personnel and health
insurance representatives. This audience consists of both men and women, and they know
someone who has suffered from breast and/or ovarian cancer. Though they are usually bearers of
bad news, they personally keep a positive outlook on life and health.

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Secondary target key strategies:
After experiencing the communication, the secondary target audience will have options
for the target audience concerning breast and ovarian cancer. The barrier which exists is that
since they do not deal with cancer patients daily, they are unaware of genetic counseling services
available. The benefit that the secondary target audience will experience is learning more about
cancer risk assessment concerning the primary target audience. The benefit outweighs the barrier
because these families represented will have a greater chance of detecting cancer potentiality
earlier. The multiple channels used are an established newsletter, radio, television, posters,
brochures, invitation letters to seminars, and seminars.
Pretest strategy:
The communication channel which has been pretested is the brochure that will be
distributed throughout healthcare offices and the seminars. Women from the target audience are
shown the brochure, and are asked a series of questions in a group setting to determine its
usability. According to my pretesting target audience, the first thing that caught their eye for the
pretesting is the picture on the front of the brochure. They liked that the women on the picture
were smiling which could be a representation of them overcoming cancer. The main messages
recognized by each woman are not to be afraid of what you feel after diagnosis and there are
ways to cope with the news. The women did say that the brochure raised their interest in the
subject. In addition, they believed the wording is appropriate for the audience I targeted. They
like the layout but one woman in the group thought it would be better to integrate the other
pictures into the text. Three of the women suggest that I could use brighter colors on the
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brochure. One of the women also suggests that I should start the opening approach with
something else other than the questions.
Theoretical foundation:
The health behavior/change model used in the development of the intervention is the
Health Belief Model. This model is used to determine how ready the target audience is in
pursuing genetic counseling services.
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The confidence in their ability to take the needed action
will lead to executing early prevention methods.
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In addition, the theory is mostly used to
develop the process evaluation. Program planners will be able to understand the motivation
behind their readiness and cue to action in order to drive an effective program.
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Management Chart:
Staff Tasks Timetable
Program Grant Manager Secure grant funds One year before program start
Program Lead Auditor Delegate company funds for
advertising and promotion
Six months before program
start
Program Operations Liaison Order custom-made brochures
and posters
Three months before program
start
Program Volunteers Pretest brochures Two months before program
start
Program Operations Liaison Prepare and mail press release
to radio and television stations
One month before program
start
Program Director Purchase gift cards One month before program
start
Program Planning Team Prepare seminars, newsletter
publication, and survivorship
class materials
One month before program
start
Program Clinical Team Execute clinic trials and issue
gift cards
Every two months during the
program for a year
Program Lead Genetic
Counselor
Implement seminars Every two months during the
program for a year
Program Genetic Counseling
Team
Execute genetic counseling
sessions
One week after clinical trials
for one year
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Program Evaluation Team Implement process evaluation Every three months during the
program for a year
External Program Evaluator Implement outcome
evaluation
One month after program
completion
Table 1. Know Your Genes Foundation Program Management Chart
Budget:
Staff salary and wages - $90,000
Staff fringe benefits - $25,000
External Evaluator wage One month only - $3000
Conference room rental - $0
Radio PSA (free airtime) - $0
Television (2) PSA - $4,500/month for 2 months - $18,000
OfficeMax custom-made brochures 25 for $49.99 (50 packs) - $2499.50
OfficeMax custom-made posters - $10.99 each (25) - $274.75
Alan B. Pearson Regional Cancer Center newsletter publication - $45 for 2 months - $90
Grant funded Walmart gift cards 300 people/year for $50 each - $15,000
One-year projection of total costs associated with advertising, promotion, planning,
implementation and evaluation: $153,864.25
The necessary promotional tool during both breast and ovarian cancer awareness months
is the television PSA. Many female cancer advocates are supportive of such events advertised
during those months. The OfficeMax brochures and posters are cost effective, and are
professionally produced. Our organization has used OfficeMax in past endeavors and usually
receives discounts on printed materials. The cancer centers newsletter is well established in the
community, and is subscribed monthly by cancer patients and their families. A financial
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incentive is a typical strategy used to encourage complete program engagement.
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The Walmart
gift cards are a good incentive for full participation in the seminars and clinical trials, which
follows a free genetic counseling for trial only participation.
Issues of concern/potential problems:
Several potential problems could arise during the implementation of the Health
Communication Program Plan. Though there are 300 spots available for clinical trials, there may
be less participant involvement throughout the year. Participants may have to drop out of the trial
participation due to personal emergencies or work conflicts. To remedy this issue, planners will
have to create a waiting list from the seminar registration sheets. Another possible issue would
be our custom-made print materials having errors and need to be reprinted. This would extend
printing time and shorten time for pretesting. In addition, depending on the time of year,
inclement weather could be an issue especially since most of our target audience use public
transportation. Therefore, seminars, clinical trials and genetic counseling sessions could be
cancelled. Finally, contact information for our primary audience could be incorrect in our
records. We should expect that participants could move residence and change their numbers,
which would disrupt the outcome evaluation process.
Evaluation strategies:
The process of evaluation for the Know Your Genes Health Communication Program
commences with being perceptive to the importance of evaluation.
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In demonstration of this
perception, meeting the program objectives is an integral part of justifying the program to
management, providing evidence of accomplishment or the necessity for more resources,
increasing organizational advocacy for health communication, and encouraging ongoing
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undertakings with other organizations.
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After the initial stage, the evaluation can be conducted
successfully. The program evaluation team has to know what type of information the evaluation
will provide.
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This will include identifying the data to collect, and choosing appropriate data
collection methods then developing and pretesting the instruments.
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After data collection,
processing and analysis, the evaluation report is created and shared with others.
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The outcomes measured in the Know Your Genes Health Communication Program Plan
are identifying the nature of breast and ovarian cancer, risks, prevention and treatment
procedures, a positive outlook on cancer diagnosis, and executing the steps to proceed with
prevention procedures to delay breast and ovarian cancer. The functionality of the program will
be measured using data from telephone surveys and online surveys completed by participants
before and after the intervention. After completing each survey, a shopping gift card will be
mailed to the participant. The data will be analyzed to identify an interest in attending genetic
counseling based on the age and risk assessment of participants. In a final measurement of the
intervention, program participants who eventually proceed with genetic counseling will meet all
of the outcome measures. The evaluation should demonstrate that the seminars, posters,
brochures, cancer survivorship class, newsletter publications, and public service announcements
on local television and radio are effective aids for delivering breast and ovarian cancer awareness
to the community.