Development of an interactive precision medicine dashboard to aid in completion of germline and homologous recombination deficiency (HRD) tumor testing for newly diagnosed ovarian cancer patients to improve the use of PARP inhibitor frontline maintenance (583)

Abstract

Objectives: New approvals for upfront maintenance therapy with PARP inhibitors in ovarian cancer necessitate efficient germline genetic testing and Homologous Recombination Deficiency (HRD) testing within several months of diagnosis to aid in consideration of PARP inhibitors for frontline maintenance treatment. Despite being recommended for all newly diagnosed epithelial ovarian cancer cases, national rates of germline genetic testing are approximately 30%1. The testing process can be overly manual, prone to delays and missed opportunities for timely PARP initiation. Completion of testing often involves multiple steps, including the use of different testing companies, without a clear way to track patients’ progress in the process. A previous trial aimed at applying novel healthcare innovation techniques to this problem was conducted to identify the optimal approach to improve germline and somatic tumor testing rates in newly diagnosed ovarian cancer patients2. Based on the results of this trial, we developed and implemented an interactive precision medicine dashboard for tracking germline and HRD testing pathway completion tracking and PARP inhibitor prescribing. Methods: After previously conducting four pilots trialing various behavioral economic interventions2, it was determined that the development of an interactive dashboard would be the most effective solution to improve genetic testing completion and timely PARP delivery. We first implemented automation and choice architecture utilizing the EMR to surface missing clinical information while removing the provider’s mental burden of the work required to complete necessary testing. We then developed the “PreAct: Precision Medicine Activated” Dashboard to filter patients by priority status, clear identification of patient data, interactive notes, and data report- ing3. After the initial implementation of the dashboard, delays were noted in time to HRD testing for germline negative patients; thus, reflex HRD testing was initiated in an effort to further streamline the process. Results: After implementation, our genetic testing rates increased from 65% to 94%. We improved our time to genetic testing from a range of 100-150 days in 2019 to 20 days. Potential trends in racial disparities were identified, with 70% of current patients who missed testing being identified as Black. Given the utility of PreAct, this dashboard is being expanded to other disease sites, including abnormal somatic testing in colon/uterine cancer and metastatic breast cancer. Conclusions: The development of an interactive dashboard improves rates of genetic testing for ovarian cancer and aids in the facilitation of timely PARP initiation when applicable. The precision medicine dashboard automates work to reduce the cognitive burden for clinicians. An innovative “concierge approach” to assist patients who have missed testing could be used to “rescue” patients that have fallen off the pathway, as we have previously tested and demonstrated this method to be effective in moving patients forward in germline testing. Potential racial disparities need further exploration to ensure equitable and applicable solutions to all patients. Objectives: New approvals for upfront maintenance therapy with PARP inhibitors in ovarian cancer necessitate efficient germline genetic testing and Homologous Recombination Deficiency (HRD) testing within several months of diagnosis to aid in consideration of PARP inhibitors for frontline maintenance treatment. Despite being recommended for all newly diagnosed epithelial ovarian cancer cases, national rates of germline genetic testing are approximately 30%1. The testing process can be overly manual, prone to delays and missed opportunities for timely PARP initiation. Completion of testing often involves multiple steps, including the use of different testing companies, without a clear way to track patients’ progress in the process. A previous trial aimed at applying novel healthcare innovation techniques to this problem was conducted to identify the optimal approach to improve germline and somatic tumor testing rates in newly diagnosed ovarian cancer patients2. Based on the results of this trial, we developed and implemented an interactive precision medicine dashboard for tracking germline and HRD testing pathway completion tracking and PARP inhibitor prescribing. Methods: After previously conducting four pilots trialing various behavioral economic interventions2, it was determined that the development of an interactive dashboard would be the most effective solution to improve genetic testing completion and timely PARP delivery. We first implemented automation and choice architecture utilizing the EMR to surface missing clinical information while removing the provider’s mental burden of the work required to complete necessary testing. We then developed the “PreAct: Precision Medicine Activated” Dashboard to filter patients by priority status, clear identification of patient data, interactive notes, and data report- ing3. After the initial implementation of the dashboard, delays were noted in time to HRD testing for germline negative patients; thus, reflex HRD testing was initiated in an effort to further streamline the process. Results: After implementation, our genetic testing rates increased from 65% to 94%. We improved our time to genetic testing from a range of 100-150 days in 2019 to 20 days. Potential trends in racial disparities were identified, with 70% of current patients who missed testing being identified as Black. Given the utility of PreAct, this dashboard is being expanded to other disease sites, including abnormal somatic testing in colon/uterine cancer and metastatic breast cancer. Conclusions: The development of an interactive dashboard improves rates of genetic testing for ovarian cancer and aids in the facilitation of timely PARP initiation when applicable. The precision medicine dashboard automates work to reduce the cognitive burden for clinicians. An innovative “concierge approach” to assist patients who have missed testing could be used to “rescue” patients that have fallen off the pathway, as we have previously tested and demonstrated this method to be effective in moving patients forward in germline testing. Potential racial disparities need further exploration to ensure equitable and applicable solutions to all patients.