Sequential EHR interventions to increase genetic testing for breast and ovarian cancer predisposition across diverse patient populations in gynecology practices at Penn Medicine.

Abstract

10589 Background: Genetic testing (GT) identifies individuals who may benefit from increased surveillance and risk reduction strategies. GT is under-utilized, especially in those without a personal history of cancer and in minority populations. Methods: We identified a patient cohort meeting NCCN criteria for genetic testing utilizing electronic health record (EHR) phenotyping in 2 diverse gynecological practices. NCCN criteria included individuals with a personal history of ovarian cancer, early-onset (<50) breast cancer diagnosed before 2021, or a family history (FH) of ovarian cancer or male breast cancer. Participants with prior genetics visits were excluded. Patient nudges and provider messaging strategies were introduced to boost genetic counseling consultation. Nudges included patient portal messaging (PP) followed by texts using the Way To Health platform (WH) in those that did not respond to PP. For non-responders to patient directed nudges, genetic counseling consult orders were placed using Epic’s Pend & Send tool and sent to their gynecologist. Endpoints included the open rate for PP, response rate for the WH text, and the number of genetic counseling appointments completed. Differences between the clinics were calculated by Chi Square. Results: Of 1055 patients identified and who received a PP message regarding genetic counseling, 81% had a FH of ovarian cancer. Characteristics of the patient populations differed across clinics: Clinic D (n=505): 71.3% Black, 18% White and 67% < 45 years. Clinic R (n=550):10% Black, 83.5% White and 63% > 60 years.79% opened PP and 22.1% replied to PP, more in Clinic R (26.7% vs 17.0%, p<0.001). Patient engagement by PP or WH was 59.8% (631/1055), more in Clinic R (67.1% vs 51.9%, p<0.001). Of those that connected by patient nudges, 62.8% (396/631) declined additional follow-up (more in Clinic R, 41.5% then Clinic D, 33.3%, p=0.014), either due to incorrect family history in EHR, prior genetic testing, or, in the majority of cases, because they were not interested (296/631) (46.9%). Provider nudges added little to patient nudges with regard to GT uptake. 25% (266/1055) scheduled and 14.9% (157/1055) of the cohort completed GT appointments with no difference between the two (Clinic D 13.9% vs Clinic R 15.8%, p=NS). Conclusions: Patient directed nudges led to engagement of nearly 60% of patients in two diverse gynecology practices. 25% of individuals scheduled and 14.9% completed appointments, with continued follow-up. Although engagement in PP and WH differed between the two clinics, the number of visits did not. An EHR-based approach to identifying patients and encouraging genetic testing is a relatively low effort, scalable strategy to increase reach and encourage engagement in genetic counseling. However, a majority of patients either did not respond or did not wish to be tested. Clinical trial information: NCT05721326 .