An initiative to increase referrals for germline testing after tumor sequencing.

Abstract

413 Background: Tumor sequencing (TS) represents an opportunity to detect hereditary cancer syndromes (HCS), as HCS may be identified or suspected from TS results. Detecting HCS can affect patient treatment and allow genetic testing of relatives. Our institution noted low numbers of referrals for germline genetic testing (GGT) following TS. A quality improvement project assessed current practices and barriers for referring patients with TS findings suspicious for HCS, with the goal of building an initiative to increase referrals for this indication. Methods: Oncologists’ input was sought via two Qualtrics surveys and semi-structured interviews. We asked about demographics, familiarity with TS reports and guidelines about when to recommend follow-up GGT, TS result review workflows, cancer genetics referral practices, preferences for receiving education/updates on cancer genetics, and perceived ability to contact genetics providers. A current state process map and root cause analysis were developed based on findings. Results: Responses identified several barriers to GGT referral based on TS results. Provider-related issues included uncertainty about what TS findings necessitate referral, discrepancies in results return workflows, low priority of GGT in the care plan, absence of guidance from genetics providers, and being uncertain how to consult providers with expertise in GGT. System-level concerns included lack of integration of lab results into the electronic medical record and difficulties scheduling cancer genetics appointments. Patients may also decline referral. Provider-level concerns were seen as the most readily addressable. We used survey/interview findings to design an initiative. Most oncologists prefer to receive information on this topic from cancer genetics clinic providers (79%) and identified email (79%) and presentations at tumor boards (71%) as preferred methods for delivery. A brief presentation, tip sheet, and frequently asked questions document focused on addressing topics identified by our survey/interviews were developed. Provider education is being delivered at tumor boards with written resources provided by email. Conclusions: There are many reasons why patients with potential germline findings on TS may not be referred for GGT despite its value in patient care. We developed an educational initiative for oncologists based on survey/interview findings with the aim of increasing referrals for GGT following TS. Referral trends will be monitored to assess effectiveness of this initiative.