Overcoming barriers and improving genetic testing completion rate for hereditary cancer in an underserved population at a large safety net hospital.

Abstract

1538 Background: Genetic testing is a routine practice in oncology care as outcomes of germline testing may impact surgical recommendations, open therapeutic options, as well as inform patients and family members of their cancer risks. Lyndon B. Johnson Hospital (LBJ) is a safety-net hospital that mainly serves low income and uninsured patients (pts), and LBJ oncology clinic is staffed by MD Anderson Medical Oncology faculty and fellows. Pre-test counseling with a certified genetic counselor was offered once a week by referral and transitioned to virtual template at the start of the COVID-19 pandemic. This transition in addition to barriers unique to the underserved population led to a decrease in test completion rates and introduced a backlog as patients were re-referred for completion of testing. We discuss our strategies in decreasing a 9-month backlog over the course of one year. Methods: Re-introduction of an on-site general oncology genetic counselor twice a week was implemented in addition to maintaining the virtual platform once a week. The on-site genetic counselor was embedded in the physician’s clinic and rotated to ensure coverage for all clinic days. Manual chart review was conducted by on-site genetic counselor and patients were rescheduled to in-person template in conjunction with other same day appointments to improve no-show rate. Patients electing to proceed with germline testing signed appropriate written consent, patient assistance financial forms, and submitted samples prior to leaving clinic. Results: From January 2019 through December 2022, a total of 1716 patients including re-referrals were scheduled and 728 patients seen. When genetic counseling service was available as referral outside of oncology clinic, the completed visit rate was 48%, which decreased to 26% in 2020 after COVID- 19 transition to virtual. The visit completion rate did improve to 36% in 2021 but the most improvement was seen with genetic counselor embedded in physician clinic with 69% in 2022. The number of genetic testing also increased with 79 ordered in 2021 to 211 ordered in 2022. Of those patients who met national criteria for germline testing and expressed verbal consent, 47% completed germline testing in 2021 which improved to 83% in 2022. Conclusions: In our experience, telehealth genetic services is not ideal in the underserved population as there are unique barriers. On-site embedded genetic counseling helps eliminate barriers by allowing patients to complete all steps necessary prior to leaving clinic, leading to successful test completion rates and improved quality of care.[Table: see text]