Breast Cancer Female, Gene Mutation-Related Cancer, Genetic Predisposition to Disease, Hereditary Breast and Ovarian Cancer, Hereditary Cancer Syndrome, Hereditary Diseases, Ovarian Cancer
Conditions
Keywords
NCCN guidelines, genetic testing, hereditary cancer, breast cancer, ovarian cancer, intervention, sequential intervention, message-based intervention, text message, diverse patient population, genetics, female, digital health technology, germline genetic testing, nudge, EHR based intervention, genetic counseling
Brief summary
The goal of this sequential study design is to increase genetic testing in those meeting national clinical guidelines. The main question it aims to answer is: which intervention is most effective in uptake of genetic testing for the target population? Participants will receive genetic testing and counseling that may initiate life-saving screenings.
Detailed description
Germline genetic testing is recommended by the National Cancer Center Network (NCCN) for individuals with a personal history of ovarian cancer, young-onset (\<50 years) breast cancer, and a family history of ovarian cancer or male breast cancer, among others. Recent publications demonstrate that the uptake of genetic testing is under-utilized, overall, and rates are consistently lower in minority populations. EHR-based algorithms will be used to identify patients of two Penn Medicine Ob/Gyn practices for whom genetic testing is recommended based on NCCN guidelines and to test pragmatic methods using messages delivered to patients or clinicians to encourage testing. The ACC Electronic Phenotyping Core developed the algorithms based on cancer registry data along with family history fields and this study will develop and test messages directed at patients and clinicians to encourage testing. The aims are: 1. Identification of at-risk populations through electronic health record (EHR) searches followed by patient nudges (MPM and then Way To Health) to increase the uptake of genetic counseling referral and testing in patients at gynecology practices at Dickens Center and Penn Medicine Radnor. 2. In patients who have not responded to patient nudges (Aim 1), test a provider nudge to increase the uptake of genetic counseling referral and testing in gynecology practices at Dickens Center and Penn Medicine Radnor (Aim 2).
Interventions
OTHERSequential EHR Communications
The intervention includes 3 message types: an EHR message, followed by a text message, followed by physician nudge. Each subsequent type will be activated if the previous type does not yield a response.
Sponsors
Abramson Cancer Center at Penn Medicine
Study design
Allocation
NA
Intervention model
SEQUENTIAL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Intervention model description
Eligible patients will be sent a message through the patient portal to encourage genetic counseling and testing. If the patient does not respond, they will be sent a text message. Should there be no response, the patient's clinician will receive a nudge
Eligibility
Sex/Gender
FEMALE
Age
25 Years to 100 Years
Healthy volunteers
No
Inclusion criteria
1. Patients with serous ovarian cancer diagnosed more than two years prior to study contact 2. Patients with breast cancer diagnosed at \<50 years of age more than two years prior to study contact 3. Patients with triple negative breast cancer diagnosed more than two years prior to study contact 4. Unaffected individuals reporting a family history of ovarian cancer 5. Unaffected individuals reporting a family history of male breast cancer 6. Unaffected individuals reporting a family history of breast cancer \<50 years
Exclusion criteria
1\. Patients who have previously received genetic counseling and/or testing
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of Genetic Counseling Appointments Completed Following MPM Delivery | Within six months of MPM delivery | Scheduling and completion of genetic counseling appointments will be monitored through EHR. MPM stands for MyPennMedicine message which will be sent directly to the patient through the medical record. |
| Number of Genetic Counseling Appointments Completed Following Provider Nudge | Within six months of provider nudge | Scheduling and completion of genetic counseling appointments will be monitored through EHR. The provider nudge will be delivered as a Best Practice Alert (BPA) upon opening the patient's chart. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Open Rate of MPM | Within one month of receiving MPM | The proportion of eligible participants who open the invitation to receive genetic counseling and testing compared to the total amount of eligible participants sent an MPM. |
| Response Rate of Way To Health text | Within one month of receiving text | The proportion of eligible participants who respond to a text message invitation to receive genetic counseling and testing compared to the total amount of eligible participants sent a Way To Health (WTH) text. |
Countries
United States
Outcome results
None listed