Patient Choice or Consent¶
“Patient Choice” (aka Consent) is taken from patients when a test is ordered in TOMS. A record of the patient choice decisions is visible for both Rare Disease and Cancer cases in the GMS Interpretation Portal.
Patient Choice can be seen in two places:
-
On the Referral grid - a column on the right-hand side called Patient Choice A flag system depicting overall consent status for the referral. A green flag indicates positive primary consent of all sequenced individuals to genomic testing. An amber flag indicates that the consent status of least one sequenced individual is “n/a” and no sequenced individual has ambiguous or negative consent. A red flag indicates that at least one sequenced individual has ambiguous or negative consent.
-
On the Refferal Overview page, there is also a patient choice column beside each patient in a family that shows
Yesif patient has given consent,Noif withdrawn consent orN/Aif there is an error or a special case of retrieving consent.
Consent is usually retrieved on the fly when the case overview page is loaded. The date consent was retrieved is displayed in brackets next to consent value.
Info
The consent value is cached and when the consent service returns a 400 or does not provide a valid response under unusual circumstances, the portal displays a cached consent value - i.e. the last known value. The date next to it should be indicative if it doesn't match the current date the case page is loaded.
Outcome 1
No consent is recorded for one or more patients and the clinician has indicated that no consent form is to be sent retrospectively indicating positive consent.
Referrals with no consent as an initial state do not enter the Interpretation Portal.
If one member of a trio does not consent, but the other two members do consent, the referral will still be blocked from the Interpretation Portal.
Patient Choice requires all patients to consent before the referral flows to the Interpretation Portal.
Outcome 2
The consent discussion has happened, however instead of filling out the consent options online through the TOMs tool, the clinician has filled out a paper consent form, either at the session or at a later date. The referral will be blocked from entering the Interpretation Portal until the consent form has been uploaded to TOMs. Once the consent form(s) have been uploaded, the referral will no longer be blocked and will be visible in the Interpretation Portal once the interpretation has been completed.
Outcome 3
If all patients have consented to testing, and the clinician has indicated this via the TOMs consent tool, the referral will flow into the Interpretation Portal once interpretation has been completed.
OR
If a patient is unable to consent, for example due to loss of mental capacity, but they assent to the test and the clinician agrees that the test is in the patient’s best interests, the referral will flow into the Interpretation Portal once interpretation has been completed.
Outcome 4
If a patient changes their mind regarding their consent - having previously consented and now wishes to withdraw - there are two possible outcomes. If the referral is already in the Interpretation Portal, the referral will stay there, and it will be in the hands of the clinician on whether to interpret the results or not.
If the referral is not yet in the Interpretation Portal, the referral will be blocked and therefore not visible in the Portal.
Display of Patient Choice¶
Patient choice in the Interpretation Portal is dynamically checked for each patient when the referral page loads.
The status for each patient will be populated on the Cancer and Rare Disease pages along with the date the patient choice was last checked.
Note
There is a small delay in the Patient Choice column updating when the case page first loads. While it is loading itcurrently displays “N/A”
In addition, there is a nightly check of the patient choice to update cases if there have been any changes added in TOMS
Patient Choice display for Cancer Referrals
Patient Choice display for Rare Disease Referrals
Patient Choice display on the referral grid¶
There is a column on the right-hand side called “Patient Choice”.
There is a flag system depicting overall consent status for the referral.
A green flag indicates positive primary consent of all sequenced individuals to genomic testing (i.e. Outcome 3).
An amber flag indicates that the consent status of least one sequenced individual has changed since the referral was made and the case registered in the portal (i.e. Outcome 4).
A red flag indicates that at least one sequenced individual has ambiguous or negative consent.