No abstract

With IRB approval, we queried the electronic medical record (EMR) for patients who were counseled and offered germline testing per NCCN guidelines from 1/29/19 e 2/3/21. Patients qualified for testing due to pathologic high risk (HR), family history (FH), or both. As referral methods evolved over time, we compared three cohorts of patients referred for testing through one of three methods. Patients were offered either 1) telephone number for a genetic counselor (TN); 2) EMR referral to a genetic counselor who calls the patient (ER); 3) same-day in-office testing (IO). The proportions of patients in each cohort who received testing were compared using chi square. Time to testing for each cohort was compared using Kaplan Meier. Multivariate logistic regression and Cox regression evaluated the independent influence of referral method and reason for referral on these outcomes. All analyses used SPSSv26.RESULTS: 177 patients were offered germline testing (47 TN, 70 ER, and 60 IO.) The cohorts did not differ in age, race, PSA, or clinical stage. The percentage of patients referred for both HR and FH was lower in the TN group compared to the ER and IO groups (6% vs 21% vs 27%, respectively, p<.025). Time to testing (Fig. 1) and receipt of testing was significantly associated with the referral method. Testing was obtained in 8 (17%) of TN, 39 (56%) of ER referrals and 39 (65%) of IO (p<0.001). 47/96 (49%) of men with family history, 16/47 (34%) of those with high risk and 23/34 (68%) of those with both risk factors obtained testing (p[0.012). Multivariate analyses indicated that referral method was independently associated with receipt of test and time to test (p < .001) while reason for testing was not significant. CONCLUSIONS: In-office germline testing is the most effective and expedient method to obtain germline testing results.