A personalized digital approach to cancer risk assessment in a diverse gynecology clinic.

Abstract

e22642 Background: Most individuals who qualify for cancer genetic testing and enhanced breast cancer screening are not identified. We aim to sustainably integrate digital cancer risk assessment into the daily workflow of a gynecology clinic. Methods: In an effectiveness-implementation quality improvement (QI) study in an urban academic gynecology practice serving patients with public insurance, a digital tool (DT) for cancer risk assessment was launched to identify those who meet NCCN (National Comprehensive Cancer Network) criteria for hereditary cancer screening and generate a Tyrer-Cuzick (TC) score. New gynecology patients > 18 years were invited to complete the DT via secure portal-based text messaging. Data were collected through chart review. Statistical analysis was performed using Stata version 19. Results: During 6 weeks pre-implementation, 131 new gyn visits were seen (median age 42). At least 14 (10.7%) patients were eligible for genetic testing by NCCN criteria, among which 1 was counseled and 3 had prior testing. Only 1 patient had a TC score calculated. In the initial 6 weeks post-implementation, 171 new patients were seen (median age 41), of which 153 were sent the DT with 82 (53.6%) completing it. Among this group, 18 (22.0%) met NCCN criteria for genetic testing and 12 (14.6%) had a TC score exceeding 20%. 21 of 24 (87.5%) patients meeting NCCN criteria and/or with an elevated TC score were counseled and/or referred to Genetics and Personalized Cancer Prevention Program (GPCP). In the first 6 weeks post-implementation, the QI team was onsite providing education and assistance. In the subsequent 5 weeks, there was no difference in DT completion rates (53.6% vs. 51.1% respectively, p = 0.70). In the absence of the QI team, there was a significant increase in “missed patients" (0% vs. 40% respectively, p < 0.001). For “missed patients” or patients with abnormal results on the DT that were not counseled, the QI team contacted the provider and encouraged follow-up with the patient. Conclusions: The QI initiative demonstrated a short-term sustainable effort to screen patients for increased cancer risk, with challenges in follow-up identified. This quality improvement project is working iteratively to implement universal personalized risk-based cancer prevention. Pre-Implementation(6 weeks, n = 131)n / n (%) Post-Implementation (6 weeks, n = 153)n / n (%) p-value Completed DT / Received DT - 82 / 153 (53.6) - Meet NCCN criteria for genetic testing 14 / 131 (10.7) 18 / 82 (22.0) - TC Score Calculated 1 / 131 (0.76) 77 / 153 (50.3) < 0.001 TC Score > 20% 0 / 1 (0) 12 / 82 (14.6) - Meet NCCN and/or TC Score > 20% 14 / 131 (10.7) 24 / 82 (29.3) - Referred to GPCP 0 / 14 (0) 14 / 24 (58.3) < 0.001 Documented discussion of risk/Genetic testing already done/Prior GPCP Referral/Declined GPCP Referral 4 / 14 (28.6) 7 / 24 (29.2) 0.97 Cancelled Appointment - 3 / 24 (12.5) - No documented discussion of risk or GPCP referral (missed) 10 / 14 (71.4) 0 / 24 (0) < 0.001