Feasibility of an electronic risk score questionnaire in rural practice.

Abstract

e19014 Background: Genetic testing (GT) has significant implications for cancer management. Its implementation is difficult in small rural practices (RP). We examined an electronic risk Score questionnaire (ERSQ) that blends genetic risk factors with clinical and cancer family history to determine its feasibility. Methods: Clinic encounters between Oct 18 - Jan 20 were evaluated. Prior to Oct 19 patients were screening based on physician recommendation (PRBS) without an established screening questionnaire. Between Oct 19 - Jan 20 an ERSQ on a tablet identified patients meeting either USPSTF (US preventative Task force), NCCN (National comprehensive cancer center) or ASBS (American Society of Breast Surgeons) guidelines for GT. Statistical analysis was performed using paired t-test. Out of pocket costs (OOP$), prevalence, patient care impact, High risk negative (HRN) requiring change in screening recommendation (CSR) were evaluated. Genetic telephonic genetic counselling was offered to patients. Results: Pre-ESRQ cohort covering 12 months included 3520 patient encounters; with 1024 encounters post-ESRQ lasting 90 days. Forty three GT’s were performed over 16 months. Pre-ESRQ, seventy three patients were offered PRBS. Sixteen were tested (22% compliance), 13 reported out with two positive results (15% prevalence) and one HRN requiring CSR in 23% (3/13). Post ESRQ, 257 patients were offered GT; 68/131 (51% compliance) (p < 0.0001) screened with the ESRQ met at least one criteria for GT with one positive GT (1/18; 5% prevalence) and 4 HRN; CSR 5/18 (28% CSR)(p < 0.0003). In the Post ESRQ cohort GT was cancelled due to cost burden to patients in 6/27 (22%) and in 2/18 (11%) of the pre ESRQ group (p < 0.0001). Out of 26 patients with OOP$ information 23/26 (88%) incurred a zero OOP$. ESRQ took a median of 8 minutes in the office. Conclusions: An effective tablet based ESRQ may be feasible to adapt in a busy RP and help address disparity in access to genetic screening. There may be a beneficial effect on compliance with limited cost burden to patients that needs further study. ESRQ can improve CSR. A larger prospective cohort may help confirm these findings.