Kalyani Narra, MD, discusses overcoming barriers to genetic counseling in safety-net care

In this video regarding the Urologic Oncology study “Prostate cancer-related genetic counseling in a safety-net healthcare setting,” Kalyani Narra, MD, highlighted several system-level factors at JPS Health Network that contributed to high completion rates of genetic counseling visits, despite the access barriers commonly seen in underserved populations.¹

Narra emphasized that a key driver of success was the integration of genetic counseling services within the existing oncology care infrastructure. Although JPS does not directly employ genetic counselors, it contracts with UT Southwestern, a large academic institution in the Dallas–Fort Worth area. These genetic counselors are physically housed within the oncology infusion center, allowing patients to receive counseling in the same building where they attend oncology appointments. Scheduling is handled by the same clinic staff, creating a seamless, centralized system that reduces fragmentation of care.

To address high no-show rates typical of safety-net settings, JPS implemented proactive scheduling practices. Clinic staff are trained to repeatedly contact patients and reschedule missed appointments at least twice, giving patients multiple opportunities to attend. Financial barriers were also mitigated through institutional grants and established assistance programs that cover both counseling visits and genetic testing costs. Transportation challenges were addressed through insurance-supported options and ride assistance programs, such as Uber vouchers, for in-person visits. Language access was another important factor: Approximately 18% of study participants were Spanish-speaking, and in-person or interpreter services were consistently available. Regarding genetic testing practices, Narra noted that JPS has long used multigene panel testing rather than single-gene assays. For patients with prostate cancer, a comprehensive 48-gene hereditary cancer panel has been standard since before 2018 and has remained unchanged over time. Although national guidelines such as National Comprehensive Cancer Network criteria have evolved, the testing platform itself has stayed consistent, enabling detection of clinically relevant mutations including BRCA and mismatch repair genes.

REFERENCE

1. Mbonu P, Mersch J, Heady J, et al. Prostate cancer-related genetic counseling in a safety-net healthcare setting. Urol Oncol. 2025 Dec 29:110967. doi: 10.1016/j.urolonc.2025.12.003