Implementation of a Telehealth Genetic Testing Station to Deliver Germline Testing for Men With Prostate Cancer

Abstract

PURPOSE: Germline testing for men with prostate cancer (PCa) poses numerous implementation barriers. Alternative models of care delivery are emerging, but implementation outcomes are understudied. We evaluated implementation outcomes of a hybrid oncologist– and genetic counselor–delivered model called the genetic testing station (GTS) created to streamline testing and increase access. METHODS: A prospective, single-institution, cohort study of men with PCa referred to the GTS from October 14, 2019, to October 14, 2021, was conducted. Using the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework, we described patients referred to GTS (Reach), the association of GTS with germline testing completion rates within 60 days of a new oncology appointment in a pre- versus post-GTS multivariable logistic regression (Effectiveness), Adoption, Implementation, and Maintenance. Because GTS transitioned from an on-site to remote service during the COVID-19 pandemic, we also compared outcomes for embedded versus remote GTS. RESULTS: Overall, 713 patients were referred to and eligible for GTS, and 592 (83%) patients completed germline testing. Seventy-six (13%) patients had ≥ 1 pathogenic variant. Post-GTS was independently associated with higher odds of completing testing within 60 days than pre-GTS (odds ratio, 8.97; 95% CI, 2.71 to 29.75; P < .001). Black race was independently associated with lower odds of testing completion compared with White race (odds ratio, 0.35; 95% CI, 0.13 to 0.96; P = .042). There was no difference in test completion rates or patient-reported decisional conflict for embedded versus remote GTS. GTS has been adopted by 31 oncology providers across four clinics, and implementation fidelity was high with low patient loss to follow-up, but staffing costs are a sustainability concern. CONCLUSION: GTS is a feasible, effective model for high-volume germline testing in men with PCa, both in person and using telehealth. GTS does not eliminate racial disparities in germline testing access.

TARGET: A Randomized, Noninferiority Trial of a Pretest, Patient-Driven Genetic Education Webtool Versus Genetic Counseling for Prostate Cancer Germline Testing

“…This is aligned with many previous studies that have assessed alternate delivery models for pretest genetic education on the basis of evaluation of decisional conflict for informed decision making for GT. 24 , 27 , 28 …”

Digital Health Tools in Genomics: Advancing Diversity, Equity, and Inclusion

“…Considering some of these determinants during the needs assessment phase allows researchers and implementers to select and tailor appropriate implementation strategies to address them. For example, considering complementary strategies to integrating digital technologies with low-tech options may include integrating peer moderators and community peer advisors, having interpreters, language translations, public health kiosks, and community support can help increase reach and effectiveness in specific populations (e.g., underserved patients with limited health literacy, reading capacity and computer experience) [9, 19]. Planning and tracking implementation strategies used to improve accessibility and monitoring their impact on outcomes will help build evidence of their effectiveness that can be transferred to other settings or tools.…”

Casting a Wide Net While Building a Safety Net: Addressing Disparities in Genetic Testing for Hereditary Cancer

“…In all areas where this model has been implemented, increases in testing rates and decreases in time to testing have been observed. 7,8 However, as in so many other areas of healthcare, technology and automation are only part of the answer. Data from the genetic testing station demonstrated that racial disparities in test completion persisted in this model.…”

“…Data from the genetic testing station demonstrated that racial disparities in test completion persisted in this model. 7,8 These findings led to the other important component of increasing equitable access: a support system for patients identified as appropriate candidates for testing but who do not complete a routinized process.…”