Helix: A Digital Tool to Address Provider Needs for Prostate Cancer Genetic Testing in Clinical Practice
2021
Abstract Background Prostate cancer (PCA) germline testing (GT) is now standard-of-care for men with advanced PCA. Thousands of men may consider GT due to clinical and family history (FH) features. Identifying and consenting men for GT can be complex. Here we identified barriers and facilitators of GT across a spectrum of providers which informed the development of Helix – an educational and clinical/FH collection tool to facilitate GT in practice. Materials and Methods A 12-question survey assessing knowledge of genetics PCA risk and FH was administered December 2017-March 2018 in the Philadelphia area and at the Mid-Atlantic AUA meeting (March 2018). Responses were analyzed using descriptive statistics. Semi-structured interviews were conducted with medical oncologists, radiation oncologists, and urologists across practice settings from March-October 2020 as part of a larger study based on the TICD framework. Helix was then developed followed by user testing. Results Fifty-six providers (50% urologists) responded to the survey. Multiple FH and genetic knowledge gaps were identified: only 66% collected maternal FH and 43% correctly identified BRCA2 and association to aggressive PCA. Genetic counseling gaps included low rates of discussing genetic discrimination laws (45%). Provider interviews (n=14) identified barriers to FH intake including access to details and time needed. In user testing (n=10), providers found Helix helpful for FH collection. All providers found Helix easy to use, suggesting expanded clinical use. Conclusion Helix addressed multiple GT knowledge and practice gaps across a spectrum of providers. This tool will become publicly available soon to facilitate PCA GT in clinical practice. Micro Abstract Prostate cancer (PCA) germline testing (GT) informs precision therapy, screening, and hereditary cancer risk. Identifying and consenting for GT is complex, requiring new practice strategies. We identified multiple knowledge and practice gaps among a spectrum of providers which informed the development of Helix, a digital educational and clinical/family history collection tool. User testing was promising, supporting clinical use of Helix.
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