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This multisite pilot study evaluated oncology nurses’ baseline knowledge, perceptions, attitudes, and comfort with genomics and genetics in clinical practice, as well as the impact of a targeted educational intervention. The intervention included a one-hour virtual webinar focused on genetics and genomics, supplemented by three educational handouts. Participants completed pre- and postintervention surveys adapted from the Genetic and Genomic Literacy Assessment to assess changes in knowledge and confidence. The study was conducted across three community oncology tertiary hospitals. A total of 41 nurses completed the preintervention survey, and 23 completed the postintervention survey. Results showed a statistically significant improvement in nurses’ self-reported comfort levels following the intervention (P = 0.01-0.04). Although knowledge scores did not increase significantly, findings revealed persistent knowledge gaps, with 81.3% of participants answering questions related to genetic testing incorrectly. Perception and attitude measures indicated strong support for genomics education, with all participants endorsing this type of training. The findings suggest that genomics education can enhance nurses’ confidence, strengthen their ability to educate patients, improve their understanding of genetics and genomics, and reinforce the importance of these competencies in oncology care. Overall, this pilot study demonstrates the positive impact of educational interventions on nurses’ comfort and preparedness to integrate genomics into oncology practice.
Since the completion of the Human Genome Project in 2003, precision oncology has rapidly advanced from lab research to clinical practice, improving patient outcomes1-4 and showing potential for cost-effective care.5 Declining costs of gene sequencing have encouraged the inclusion of gene-informed treatments in guidelines, many of which are now standard of care in community oncology. The landscape of oncology drug approvals from 2000 to 2022 was largely driven by targeted therapies, with cytotoxic agents accounting for only 9% of the 573 newly approved treatments.6 Studies have shown that many nurses have a limited understanding of genetic principles, terminology, and pharmacogenomics.6-9 Nursing curricula across all levels lack adequate genomic content, impairing nurses’ ability to assist patients in making informed treatment decisions.10 In 2019, over half of registered nurses (RNs) had no pre-licensure education on the American Nurses Association’s genomic and genetic competencies.11 Recent Oncology Nursing Society (ONS) data show that 72% of nurses lacked genomics training in undergraduate programs, and 45% rated their knowledge as poor.7 There are also ethical and legal concerns that can contribute to nurse hesitancy in these discussions with patients.12
To close this gap, nurses must acquire the necessary knowledge about genomics and genetics, as well as understand and feel comfortable with the practical, ethical, and legal aspects of precision oncology medicine. Doing so will enable nurses to advocate for patients and enhance the delivery of cancer care.13,14 Below are findings from a multisite intervention pilot study that explored nurses’ baseline knowledge, perceptions, attitudes, and comfort levels regarding genomics and genetics in the oncology practice setting and measured the outcomes following an educational intervention.
Chief Nursing Officers (CNOs) at three community oncology tertiary hospitals in Illinois, Arizona, and Georgia forwarded the Institutional Review Board (IRB)-approved email invitation for pilot participation to their nursing staff. Forty-one participants completed the preintervention survey (pre), while 23 completed the postintervention survey.
All pilot participants took an identical pre and post survey adapted from the Genetic and Genomic Literacy Assessment, which focused on participants’ perception, attitudes, and comfort levels about genomic topics as they relate to oncology patients.15 The Genomic Knowledge section had five multiple-choice questions. Using a Likert scale, these five questions explored perceptions/attitudes about genomic integration, with four of the questions also surveying comfort level. Demographic data included, but were not limited to, age, gender identity, education level, years in practice as a nurse for patients with cancer, national certification status, role, and area of work. Participants were able to access the IRB-approved consent with survey questions through QR codes, which directed them to an anonymous Microsoft Forms survey. The preintervention QR code was sent to all nurses who signed up to attend the educational webinar; the postintervention QR code was sent only to those who completed the educational webinar.
Following the preintervention survey, participants completed a one-hour educational virtual webinar based on the American Nurses Association’s Essentials of Genomic Nursing Competencies and Outcome Indicators.16 Written material resources on biomarker testing, hereditary cancer, and the next-generation sequencing toolkit, freely provided by the Oncology Nursing Society (ONS), were made available to registered attendees. Participants were instructed to complete the preintervention survey, attend the intervention webinar, and review the additional resources before completing the postintervention survey.
Quantitative analysis of pre and post surveys via IBM SPSS Statistics (Version 28) was conducted using a χ2 test.
An average between the pre and post demographic data revealed that 50% of participants had a baccalaureate degree and 35% had a master’s, while 15% either had a different degree or chose not to answer. Fifty-one percent of the participants held administrative roles, while 27% had direct patient care. The remaining 22% held a variety of positions across the healthcare system. Thirty-seven percent had 21 or more years’ experience in cancer nursing, whereas 32% had 11 to 15 years of experience. Thirty-nine percent of participants held national certification in oncology.
Though there was no statistically significant increase in knowledge gained on the genomic and genetic questions between pre and post survey results, the data demonstrated that participants understood genomics better after the education. The majority responded correctly to four of the five questions, ranging from 65.6% to 95.3%. The definition of a somatic cell mutation received only 65.6% correct responses, while the question on genetic testing demonstrated a significant knowledge deficit, with an average of 81.3% incorrect responses. Understanding what it means to have 40% penetrance of a disease had 78.1% correct responses; 79.7% correctly responded to understanding what carrying one allele of the BRCA1 gene associated with breast cancer means; and 95.3% responded correctly to a nurse’s response to a client stating they are concerned about losing their health insurance if they test positive for any genetic disease.
All five questions had no significant impact following the educational intervention. An average between pre- and postintervention demonstrated that 100% of nurse participants supported genomic and genetic education. However, the motivation to learn about genomics in the clinical environment was shared by only 53.1% of respondents who strongly agreed. Half of the participants (54.7%) strongly agreed with the question, “Taking a genetics and genomics course would help integrate content more fully.” Additionally, 56.3% of respondents strongly agreed on the importance of oncology nurses advocating for patients and society regarding ethical and legal issues.
Four questions explored participants’ comfort level. No participants reported feeling extremely comfortable, nor very comfortable, while 31.7% to 60.3% were somewhat comfortable, and 39.7% to 68.3% were not comfortable. Only 31.7% were comfortable in explaining the Mendelian inheritance patterns to patients; 42.9% in collecting a patient’s family history, drawing a 3-generation pedigree and analyzing that pedigree; and 47.6% in teaching the concepts of genomics to fellow nurses. Interestingly, 60.3% were comfortable in sharing their knowledge of genomics/genetics in practice.
This small-scale multistudy aimed to evaluate the impact of a focused genomic educational intervention on oncology nurses’ confidence and understanding of genetics and genomics. Findings showed that, although there was no statistically significant shift in overall knowledge or perceptions and attitudes, the educational intervention notably increased nurses’ comfort in handling genomic and genetic content. Increased comfort levels indicate that even a short educational intervention can enhance nurses’ confidence in working with this subject matter, a key factor for effective patient care and communication in precision oncology. These findings are supported by the ONS 2024 report, which suggests that nurses can benefit from targeted resources that build confidence and familiarity with these concepts, and the ONS Learning Library was designed to address this gap.7 Comfort and self-efficacy are important foundations for integration of these concepts into clinical care.9 Focused education improves nurses’ comfort and is an important step toward integrating genomics into routine oncology practice, which can be achieved with brief genomic education to improve nursing preparedness and confidence. Findings reinforce the need for ongoing genomic competency development across oncology programs and clinical practice.
A significant limitation of the pre- and postintervention data collection was that it did not allow for pairing to a particular individual; thus, the data obtained were not paired for analysis, though the results did reflect group-level trends. Sample size was considerably small, and postintervention data (n = 23) were almost half the size of the preintervention data (n = 41), hence, generalizability was minimized with possible response bias. Prevalidated instruments with established reliability and content validity were chosen for alignment with the study’s aims, population, and constructs of interest.15 Their use ensured methodological rigor and susceptibility to measurement error.
As precision oncology testing and treatment become more integrated into oncology care, there is a growing need for nurses to be knowledgeable and confident in using genomic and genetic information in clinical settings. In their roles as patient advocates and educators, nurses are often the first point of contact for patients undergoing precision oncology testing and treatments. The nurses’ ability to clearly explain these complex concepts to patients can significantly influence patient comprehension, satisfaction, and adherence to personalized treatment plans. Integrating a brief, streamlined educational intervention focused on understanding and application of genomic content can prepare nurses to implement these impactful scientific discoveries into clinical practice. Specifically, comfort levels with augmented knowledge can empower nurses, leading to:
Equipping oncology nurses with genomic and genetic literacy enhances their confidence and competence, highlighting the need to integrate this content into ongoing professional development. A real-world approach to building nursing capacity in genomics and genetics is an area that directly influences patient communication, equitable access to precision oncology, and the operational readiness of cancer programs adopting molecular-driven care. These findings address a well-recognized gap in the oncology workforce and strongly support the adoption of comprehensive genomic and genetic competencies and outcome indicators to ensure that nurses remain at the forefront of oncology care.
Vicki Doctor, MS, BSN, BSW, RN, OCN, is Director of Precision Medicine at City of Hope Chicago, Atlanta, and Phoenix. Leighsa Sharoff, EdD, PMHNP/CNS, AHN-BC, CNE, ANEF, is Associate Professor and Specialty Director for Online Nursing Education Programs at Hunter College School of Nursing. Kimberly Crum, BSN, RN, OCN, is Manager of Magnet Programs & Education and Magnet Program Director at City of Hope Atlanta. Stephanie Barendt, DNP, RN, NE-BC, is Director, Clinical Excellence, Education, and Magnet Programs, at City of Hope Phoenix. Laura Moreno, MSPH, LCGC, is a licensed and certified genetic counselor in Clinical Cancer Genomics at City of Hope Atlanta. Mychala Scozzaro, BSN, RN, OCN, is a medication acquisition specialist, Precision Medicine, at City of Hope Chicago, Atlanta, and Phoenix. Eric Fowler, MS, LCGC, is Manager of Clinical Cancer Genomics at City of Hope Atlanta, Chicago, and Phoenix. Karina Szymulanska-Ramamurthy, PharmD, PhD, ACRP-CP, is Clinical Research Manager of the IITs Program at City of Hope Chicago, Atlanta, and Phoenix. Kate Sweeney, DNP, RN, ACNS-BC, AOCNS, NE-BC, is Director of Clinical Excellence, Education, and Magnet Programs at City of Hope Chicago.
