CADRe

Consent & Disclosure Recommendations

The CADRe model provides communication strategies for genetic testing consent and disclosure discussions. CADRe aims to improve access to genetic information while meeting patients' psychosocial and informational needs.

The Model

As genomic information is increasingly incorporated into healthcare, it is paramount to support clinicians in providing genetic services. ClinGen’s Consent and Disclosure Recommendations (CADRe) working group has developed rubrics that provide guidance regarding communication approach. We propose three possible communication approaches: (1) traditional genetic counseling with a genetics specialist, (2) targeted discussion with an ordering clinician, or (3) brief communication supported by educational resources.

Traditional Genetic Counseling
  • In depth discussion with clinician with genetics expertise (>30 min)
  • Information gathering for detailed risk assessment (e.g., family history)
  • Detailed discussion of condition of concern
  • Detailed discussion of genetic testing
  • Address patient questions
  • Educational materials provided, if available
   
Targeted Discussion
  • Conversation with ordering clinician (<15 min)
  • Brief discussion of condition of concern
  • Brief discussion of key elements of genetic testing
  • Brief assessment of need for traditional genetic counseling
  • Address patient questions
  • Educational materials provided, if available
   
Brief Communication
  • Short (<5 min) conversation with clinician (phone, portal, etc)
  • Supported by educational resources
  • Resources could be print, interactive, online, patient portal, etc
  • Brief assessment of need for more involved communication approach
  • Resources provided would be written:
    • In lay language
    • At an appropriate reading level

 

Model Rationale

The CADRe framework that supports this model was initially developed by experts in the CADRe working group. The framework was refined based on feedback from focus groups and interviews with genetics clinicians, non-genetics clinicians, and families who have undergone genetic testing. Here is what we've identified as times when each of the communications approaches would be recommended.

CADRe in the Clinic

Our intent is that ordering clinicians would have access to CADRe recommendations at the time of coordinating testing and disclosing results, and that they would combine this with their knowledge of the patient to determine their ultimate communication approach. We encourage clinicians to consider using the CADRe recommendations when they are: 1) comfortable discussing the diagnosis 2) comfortable choosing the appropriate genetic test, 3) comfortable assessing patient understanding and 4) comfortable knwoing when to consult with or refer to a genetics trained provider.

For more information about the process used to develop this tool, see our publication: