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Germline genetic variants that impact cancer risk, prevention, and treatment strategies are implicated in up to 20% of cancers; however, only a fraction of people at risk for hereditary cancer syndromes undergo diagnostic genetic testing. Barriers to testing, at both the patient and provider levels, include gaps in knowledge and poor access to specialty genetics services.
This multiphase project seeks to employ practice-level and patient level interventions to increase the proportion of patients in whom family history is documented and assessed for genetic risk and in whom guideline-concordant genetic evaluation is completed. This proposal leverages existing partnerships between a statewide oncology network, public health agencies, payers, and a multidisciplinary team at the University of Michigan to encourage systematic family history ascertainment and genetic risk assessment among newly diagnosed cancer patients cared for in 68 medical and gyn-oncology practices. In partnership with the Michigan Department of Health and Human Services and the Michigan Oncology Quality Consortium, we will deploy interventions to promote collection and assessment of family history and genetic evaluations for eligible patients with breast, colorectal, ovarian, prostate, and endometrial cancer cared for in diverse clinical and geographic settings across the state.
Aim 1: Test the impact of innovative practice-based interventions on the proportion of patients who have a comprehensive family history documented in their medical record.
Aim 2: Evaluate the impact of two behavioral interventions (tailored messaging via mobile optimized web interface vs. genetic counseling using motivational interviewing) on uptake of genetic testing among patients with cancer who meet clinical criteria and disclosure of genetic test results to at-risk relatives.
Aim 3: Conduct longitudinal follow up of cancer patients, exploring update of cascade genetic testing in families with germline mutations.
This study is funded by an U01 grant (CA047866) from the National Cancer Institute (NCI) within the National Institutes of Health (NIH).
Elena Stoffel, MD, MPH, Principal Investigator
Jennifer Griggs, MD, MPH, Principal Investigator
Ken Resnicow, PhD, Principal Investigator
Scott Roberts, PhD, Co-Investigator
Wendy R. Uhlmann, MS, CGC, Co-Investigator