Waldman Richard N, DeFrancesco Mark S, Feltz John P, Welling Daniel S, Neiman Wade A, Pearlstone Melissa M, Marraccini Christine A, Karanik Dana, Mielcarski Elaine, Schneider Logan, Lenz Lauren, Smith Edith C, Taber Katherine Johansen, Adkins Royce T
Associates for Women's Medicine, North Syracuse, New York; Women's Health Connecticut, Waterbury, and Women's Health Connecticut, Manchester, Connecticut; Lifeline Medical Associates, The Women's Care Source, Morristown, New Jersey; Associates for Women's Health Services of Central VA, Inc, Lynchburg, Virginia; and Myriad Genetics Inc, Salt Lake City, Utah.
Obstet Gynecol. 2025 Feb 1;145(2):177-185. doi: 10.1097/AOG.0000000000005799. Epub 2024 Dec 5.
To use online screening and virtual patient education tools to improve the provision of hereditary cancer risk assessment.
We conducted a prospective, single-arm study in which clinicians at five U.S. community obstetrics and gynecology practices underwent an 8-week observation followed by 3-4 weeks of training on online patient screening and virtual patient education (prerecorded video with or without a genetic counselor phone call) for genetic testing-eligible patients. After a 4-week practice period, hereditary cancer risk assessment and patient education metrics were collected at 8 weeks and compared with preintervention metrics using univariate conditional logistic regression models stratified by site. The primary outcome was the change in genetic testing completion rate. Clinicians and patients were invited to complete a satisfaction survey.
A total of 5,795 and 5,135 patients were seen before and after the intervention, respectively. The proportion of screened patients meeting testing guidelines increased from 21.6% before the intervention to 28.2% after the intervention (odds ratio [OR] 1.36, 95% CI, 1.26-1.47, P <.001). Guideline-eligible patients were significantly more likely to be offered genetic testing (59.1% vs 89.1%, OR 2.06, 95% CI, 1.87-2.27, P <.001), to submit a sample (32.9% vs 45.0%, OR 1.49, 95% CI, 1.27-1.74, P <.001), and to complete testing (16.0% vs 34.2%, OR 2.38, 95% CI, 2.00-2.83, P <.001). Most clinicians agreed or strongly agreed that the screening tool improved the identification of patients meeting hereditary cancer risk assessment guidelines (92.1%), saved time (64.9%), and was easy to incorporate (68.4%) and that patient education improved their ability to deliver hereditary cancer risk assessment standard of care (84.2%). Most patients agreed or strongly agreed that virtual education helped them understand the purpose (91.7%) and implications (92.6%) of genetic testing.
A guideline-based online patient screening tool and virtual patient education were well received. The online tool enabled identification of significantly more guideline-eligible candidates for hereditary cancer risk assessment, and education improved patients' genetic literacy. Together, these tools ultimately improved the genetic testing completion rate.
使用在线筛查和虚拟患者教育工具来改善遗传性癌症风险评估的提供情况。
我们进行了一项前瞻性单臂研究，美国五家社区妇产科诊所的临床医生先接受了为期8周的观察，随后接受了为期3 - 4周的关于在线患者筛查和虚拟患者教育（有或没有遗传咨询师电话的预录制视频）的培训，针对符合基因检测条件的患者。在为期4周的实践期后，在第8周收集遗传性癌症风险评估和患者教育指标，并使用按地点分层的单变量条件逻辑回归模型与干预前指标进行比较。主要结局是基因检测完成率的变化。邀请临床医生和患者完成满意度调查。
干预前和干预后分别共诊治了5795名和5135名患者。符合检测指南的筛查患者比例从干预前的21.6%增加到干预后的28.2%（优势比[OR]1.36，95%置信区间，1.26 - 1.47，P <.001）。符合指南条件的患者接受基因检测的可能性显著更高（59.1%对89.1%，OR 2.06，95%置信区间，1.87 - 2.27，P <.001），提交样本的可能性更高（32.9%对45.0%，OR 1.49，95%置信区间，1.27 -
