Increasing Germline Genetic Testing for Patients With Cancer

Conditions studied

Hereditary Pancreatic Cancer, Conditions or Focus of Study, Hereditary Breast Cancer, Hereditary Colorectal Cancer

About this study

Germline testing for hereditary cancer syndromes is underutilized across most health care settings. Using a learning health care approach, the Genomics-enabled Learning Health Systems (gLHS) network aims to evaluate the impact of a suite of implementation strategies to increase germline test ordering by oncology care teams (i.e., mainstreaming) for eligible patients with breast, pancreatic or colorectal cancer. Secondarily, the study will investigate completion of testing by eligible patients, as well as impact on overall rates of germline test ordering in patients with cancer. The network will bundle and deploy different implementation strategies across the clinical sites in three 6-month phases. A maintenance phase after the implementation periods will measure genetic testing rates without any additional implementation strategies to determine persistence of effects. The implementation strategies address clinician-level factors, and thus oncologists and their team members (e.g. advanced practice providers, nurse navigators, case managers) will be the focus of evaluating the impact of implementation strategies. Strategies that will be considered include provider education, audit and feedback reports, facilitation, peer support, and electronic health record (EHR) system optimization to support germline testing. Using the RE-AIM QuEST framework, outcomes will be assessed using mixed methods separately for each eligible cancer type. Data collection from the EHR, other relevant data sources, and qualitative provider feedback will be used to assess ordering and completion of tests and the effect of the implementation strategies on germline testing rates in oncology clinics.

Interventions

• Behavioral: Implementation strategies — We will deploy different strategy bundles across the clinical sites in three approximate 6-month phases. Phase I - Facilitation of provider training, educational materials, and information resources; Patient-facing educational material and information resources Phase II - Audit and feedback report on existing patients; Practice champion support; Optimizing EHR strategies Phase III - EHR tools to facilitate prospective identification of patients, testing, and result reporting

Primary outcomes

• Germline Genetic Testing Ordered for Breast Cancer Patients (48 months)
• Germline Genetic Testing Ordered for Pancreatic Cancer Patients (48 months)
• Germline Genetic Testing Ordered for Colorectal Cancer Patients (48 months)

Eligibility information

Study locations

• VA Greater Los Angeles Healthcare System, Los Angeles, California 90073 United States
• Orlando VA Medical Center, Orlando, Florida 32827 United States
• Atlanta VA Medical Center, Decatur, Georgia 30033 United States
• Northwestern Medicine, Chicago, Illinois 60611 United States
• Indiana University School of Medicine, Indianapolis, Indiana 46202 United States
• Durham VA Medical Center, Durham, North Carolina 27705 United States
• Salisbury VA Health Care System, Salisbury, North Carolina 28144 United States
• Geisinger, Danville, Pennsylvania 17822 United States
• Vanderbilt University Medical Center, Nashville, Tennessee 37203 United States
• University of Utah Health, Salt Lake City, Utah 84112 United States