Using health information technology to improve collection of family cancer history: prospective randomized trial of web-based tool in a gynecologic oncology outpatient clinic

Abstract

<h3>Objectives:</h3> In the US there are approximately 4 million individuals with a genetic cancer predisposition syndrome, however, the majority are not aware and cannot benefit from genetically-targeted cancer prevention. Family cancer history (FCH) can identify high risk patients and triage them to genetic assessment, however there is wide variability in accuracy, breadth and strategies for FCH collection. We aim to evaluate whether a web-based tool (WBT) can result in improved quality of FCH versus standard FCH collection via face-to-face interview. <h3>Methods:</h3> All patients scheduled for a gynecologic oncology new patient visit between 9/2019-9/2020 were offered enrollment in an institutional review board-approved prospective trial. Patients were randomized to one of three arms: 1) standard of care FCH collection during the interview, 2) WBT administered at home prior to the visit, 3) WBT administered in the office prior to the visit. The primary endpoint was evaluation of FCH quality based on established quality measures. Chi-square test was used to compare FCH quality between intervention arms and ANOVA test for the number of relatives/generations in the pedigree. A Bonferroni correction was used to account for multiple comparison testing. <h3>Results:</h3> A total of 100 patients were enrolled. The mean age was 56.2 years (SD 15.2). The WBT was completed successfully by 67% (22) of patients randomized to home administration vs 94% (31) randomized to office administration (P=0.01). Patients cited the following reasons for failure to complete the WBT at home: difficulty with technology, concern about privacy and forgetting about the WBT invitation. In the intention-to-treat analysis, office WBT collection resulted in significantly higher quality FCH vs the control and home arms (Table 1). The WBT resulted in significantly greater mean number of relatives included in the pedigree (Arm 1 - 3.9 [SD 3.0], Arm 2 - 32.4 [SD 16.8], Arm 3 - 29.0 [SD 18.3], P<0.001) and significantly greater number of included generations (2.2 [SD 0.9], 3.9 [SD 0.4], 3.7 [SD 0.6], P<0.001). Patient age, race, ethnicity, and personal/family cancer history were not associated with FCH quality. When excluding patients who could not access the WBT at home, there were no differences in FCH quality when WBT was completed at home vs in the office. A total of 39 patients utilizing the WBT (74%) completed a satisfaction survey following the office visit; 38 (97%) reported that the WBT was easy to understand and 30 (77%) reported being satisfied with the tool. <h3>Conclusions:</h3> FCH collection is an exciting application of information technology in the current healthcare setting with a growing emphasis on cancer genetics, disease prevention and thoughtful use of WBTs. In our cohort of gynecologic-oncology patients, a WBT resulted in significantly higher quality and more comprehensive family cancer pedigrees. With the COVID-19 pandemic inspired drive to minimize in-office time, future studies must assess strategies to improve patient engagement with WBT at home prior to the visit.