Improving genetic counseling uptake for breast, pancreatic, and prostate cancers at a safety net hospital.

Abstract

11137 Background: Despite guideline recommendations, genetic counseling (GC) for BRCA associated cancers among underserved populations remain low. We conducted a QI project to increase GC uptake for patients with breast, pancreatic, and prostate (BPP) cancers seen in a safety net oncology clinic at Harris Health. Methods: Analysis of electronic medical record (EMR) data along with surveys and interviews of clinicians and staff identified: 1) a complex GC referral process with 30% unscheduled referrals in 2023, 2) lower frequency of GC appointments (appts) among established patients, and 3) clinician knowledge deficits regarding GC guidelines. Our interventions consisted of 1) developing an automated referral scheduling workflow, 2) creating an EMR report of potentially eligible patients with upcoming appts and sending monthly reminders to clinicians, and a 3) GC guidelines lecture by a genetic counselor. Results: There were 720 patients in the preintervention period (1/2020-5/2024) and 93 patients in the postintervention period (6-12/2024). In total, 50.5% of patients were Hispanic, 24.8% were Black, 53.7% spoke Spanish, and 67.4% received financial assistance. Amongst all patients, GC appts increased from 55.4% preintervention to 67.7% postintervention (p = 0.02), with increases across breast (54.6% to 67.1%), pancreatic (55.4% to 71.4%), and prostate (59.1% to 65%) cancers. Among patients meeting select NCCN GC criteria identifiable through discrete EMR data (triple negative, stage IV HER2 negative, or diagnosed age <50 breast; all pancreatic; stage IV prostate), GC appts increased from 74.0% to 82.6% (p = 0.20), with increases for breast (79.4% to 86.5%) and pancreatic (55.4% to 71.4%) cancers and a decrease for prostate cancer (71.9% to 60%). All GC referrals postintervention were scheduled, with time from GC referral to GC appts improving from a mean of 170.2 days (SD 636.1) to 27.4 days (SD 19.5) (p<0.01). Time from first oncology appt to GC appt improved from a mean of 124.2 days (SD 199.9) to 33.3 days (SD 30.5) (p<0.01). 87.5% of patients with GC appts consented to testing in 2023 and 86% consented postintervention. Conclusions: Multilevel interventions targeting both EMR capabilities as well as clinician education and awareness of eligible patients streamlined the GC referral workflow and increased GC appts among a safety net patient population with BRCA associated cancers. Patients Preintervention GC Appts(N [%] or Mean [SD]) Postintervention GC Appts(N [%] or Mean [SD]) P-Value All Cancers 339/720 (55.4%) 63/93 (67.7%) 0.024 Breast 295/540 (54.6%) 49/73 (67.1%) Pancreatic 36/65 (55.4%) 5/7 (71.4%) Prostate 68/115 (59.1%) 13/30 (65%) Select NCCN Criteria 282/381 (74.0%) 38/46 (82.6%) 0.204 Breast 200/252 (79.4%) 32/37 (86.5%) Pancreatic 36/65 (55.4%) 5/7 (71.4%) Prostate 46/64 (71.9%) 3/5 (60%) Time from GC Referral to GC Appointment (Days) 170.2 (636.1) 27.4 (19.5) <0.001