Promoting adherence to germline genetic testing for pancreatic cancer.

Authors

Heather Hannon

Heather Alison Hannon

Bon Secours Cancer Institute, Richmond, VA

Organizations

Bon Secours Cancer Institute, Richmond, VA

Research Funding

No funding received
None.

Background: Updated NCCN guidelines support universal germline genetic testing (GGT) for pancreatic ductal adenocarcinoma (PDAC), and literature recommends ordering GGT for PDAC at or near first oncology consult (Chittenden et al., 2021). However, recent studies demonstrate that adherence to updated GGT guidelines for PDAC is poor, and testing rates remain suboptimal (Klatte et al., 2023). A three-month pre-intervention audit (4/2022-6/2022) revealed that less than half of patients diagnosed with PDAC at our community cancer facility underwent GGT in alignment with NCCN guidelines, and only 33% had GGT ordered at the first oncology visit and before treatment. Automated workflows can increase GGT rates for PDAC, but community hospitals may lack infrastructure to support this type of model. Oncology Nurse Navigators (ONN) represent a practical tool for fostering guideline-concordant care for cancer patients treated in the community. The present study explored whether the use of a prompt (or alert message) facilitated by the ONN could change compliance with current recommendations for GGT at a community cancer institute. Methods: We conducted a series of four specific strategies, over a three-month period (7/2022-9/2022). 1. Targeted education was provided to oncologists about NCCN updates. 2. ONN identified newly diagnosed PDAC patients. 3. ONN implemented a prompting process (sending a message to patient’s oncologist within one week of identification of PDAC diagnosis) to review/remind about GGT. 4. Chart review was performed at designated intervals to monitor GGT ordering. The health system’s ONN tracking tool was used to gather, monitor data. Analysis was performed with SPSS software. Results: Nine PDAC patients were identified that met inclusion criteria. Following the ONN prompting intervention there was a 56% increase in PDAC patients who had testing ordered as recommended by NCCN guidelines, a 103% increase in PDAC patients who had GGT ordered at first consult and before treatment initiation. While differences between pre and post intervention were not statistically significant (Fishers Exact Test), the prompting process stimulated valuable discussion between Medical Oncologists (MO) and the ONN, possibly shaping ordering decisions. This included two MOs who switched to ordering GGT at first consult and one MO who had not been planning to order GGT and did so following the prompt. Conclusions: An ONN facilitated prompt offers a simple yet effective means for promoting adherence to GGT guidelines for PDAC in the community setting. ONNs can play a key role in identification of patients and communication and collaboration with MOs before the first oncology consult. The prompting process opens conversation and provides opportunities to clarify, educate about NCCN guidelines in the community setting.

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Abstract Details

Meeting

2023 ASCO Annual Meeting

Session Type

Publication Only

Session Title

Publication Only: Health Services Research and Quality Improvement

Track

Quality Care/Health Services Research

Sub Track

Quality Improvement

Citation

J Clin Oncol 41, 2023 (suppl 16; abstr e18737)

DOI

10.1200/JCO.2023.41.16_suppl.e18737

Abstract #

e18737

Abstract Disclosures