On-Site Nurse-Led Cancer Genetics Program Increases Cancer Genetic Testing Completion in Black Veterans.

PURPOSE: Telegenetics services can expand access to guideline-recommended cancer genetic testing. However, access is often not distributed equitably to all races and ethnicities. We evaluated the impact of an on-site nurse-led cancer genetics service in a diverse Veterans Affairs Medical Center (VAMC) oncology clinic on likelihood of germline testing (GT) completion. METHODS: We conducted an observational retrospective cohort study of patients who were referred for cancer genetics services at the Philadelphia VAMC between October 1, 2020, and February 28, 2022. We evaluated the association between genetics service (on-site v telegenetics) and likelihood of GT completion in a subcohort of new consults, excluding patients with prior consults and those referred for known history of germline mutations. RESULTS: A total of 238 Veterans, including 108 (45%) seen on site, were identified for cancer genetics services during the study period, with the majority referred for a personal (65%) or family (26%) history of cancer. In the subcohort of new consults, 121 Veterans (54% self-identified race/ethnicity [SIRE]-Black), including 60 (50%) seen on site, were included in the analysis of germline genetic testing completion. In a univariate analysis, patients who were seen by the on-site genetics service had 3.2-fold higher likelihood of completing GT (relative risk, 3.22; 95% CI, 1.89 to 5.48) compared with the telegenetics service. In multivariable regression analysis, the on-site genetics service was associated with higher likelihood of GT completion, but this association was only statistically significant in SIRE-Black compared with SIRE-White Veterans (adjusted RR, 4.78; 95% CI, 1.53 to 14.96; P < .001; P-interaction of race × genetics service = .016). CONCLUSION: An on-site nurse-led cancer genetics service embedded in a VAMC Oncology practice was associated with higher likelihood of germline genetic testing completion than a telegenetics service among self-identified Black Veterans.

The effects of stimulus pairings on autistic children's vocalizations: Comparing forward and backward pairings.

In a procedure known as stimulus-stimulus pairing (Yoon and Bennett, 2000), the experimenter pairs a target sound (e.g., "bah") with a child's preferred item (e.g., a toy). Even though the stimulus pairings proceed independently of the child's behavior, this procedure has proved capable of increasing imitation of the target sound in developmentally delayed children (Shillingsburg et al., 2015). The underlying behavioral processes remain poorly known, however, and few systematic variations of the basic procedure have been published. In the present experiment, with autistic children as participants, (a) we compared the effects of forward versus backward pairings on the imitation of target sounds, and (b) we evaluated formally the relation between the children's preexisting verbal repertoires and the efficacy of the pairing procedure. As is often reported in the Pavlovian literature, backward pairings promoted lower levels of conditional responding than forward pairings. Also, we found a negative relation between a child's verbal level and pairing efficacy: children with the lower scores on the Behavioral Language Assessment Form (Sundberg and Partington, 1998) exhibited more conditioning. These findings confirm in a single study what has been so far only suspected informally.