||1U01CA232827-01A1 Interpret this number
||University Of Michigan At Ann Arbor
||Innovative Approaches to Expand Cancer Genetic Screening and Testing for Patients & Families in a Statewide Oncology Network Through Community, State, & Payer Partnerships
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 a network of nearly
all oncology practices in Michigan, 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. The first Specific Aim is to test the impact of innovative practice-based interventions on the
proportion of patients who have a comprehensive family history documented in their medical record. In the first
phase, using a stepped-wedge design, we will provide a tablet-based family health history survey tool to
practices and evaluate the impact of the tool on quality measures of family history documentation and guideline
concordant genetic referrals. In the second phase, at Year 4, we will test the impact of adding value-based
reimbursement using family history ascertainment as the quality improvement metric. The second Specific Aim
is to 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. Our third Specific
Aim addresses longitudinal follow up of cancer patients, exploring uptake of cascade genetic testing in families
with germline mutations. These projects directly address implementation and dissemination of genomic
medicine in diverse settings and will leverage both new and well-established partnerships among community
and academic oncology practices, public health agencies, and payers in the state of Michigan. The University
of Michigan is a leader in genomic medicine, behavioral interventions with diverse populations, healthcare
policy, and implementation science, and the proposed work engages multidisciplinary expertise in caring for a
diverse patient population and developing sustainable and scalable approaches for precision oncology in
diverse healthcare settings.
Motivational interviewing for genetic counseling: A unified framework for persuasive and equipoise conversations.
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, Chen G.
, Austin S.
, Stoffel E.
, Hanson E.N.
, Gerido L.H.
, Kaphingst K.A.
, Yashar B.M.
, Marvin M.
, et al.
Journal of genetic counseling, 2022 Oct; 31(5), p. 1020-1031.
Shared Decision Making in Health Care: Theoretical Perspectives for Why It Works and For Whom.
, Catley D.
, Goggin K.
, Hawley S.
, Williams G.C.
Medical decision making : an international journal of the Society for Medical Decision Making, 2022 Aug; 42(6), p. 755-764.