Tumor genomic testing (TGT) has become increasingly adopted as part of standard cancer care for many cancers. Despite national guidelines around patient education before TGT, available evidence suggests that most patients' understanding of genomics remains limited, particularly lower-income and minority patients, and most patients are not informed regarding potential incidental germline findings.

To investigate and address limitations in patient understanding of TGT results, a Plan-Do-Study-Act (PDSA) approach is being used to assess needs, identify opportunities for improvement, and implement approaches to optimize patient education. We reviewed published guidelines related to pre-TGT provider-patient education and to identify key points (Plan). A provider quality improvement survey was completed (Do), which highlighted inconsistency in pre-TGT discussion practice across providers and minimal discussion with patients regarding the possibility of incidental germline findings.

Patient focus groups and interviews (N = 12 patients) were completed with coding of each transcript (Study), which revealed themes including trouble differentiating TGT from other forms of testing, yet understanding that results could tailor therapy. The integration of data across this initial PDSA cycle identified consistent themes and opportunities, which were incorporated into a patient-directed, concise animated video for pre-TGT education (Act), which will form the foundation of a subsequent PDSA cycle. The video addresses how TGT may/may not inform treatment, the process for TGT using existing tissue or liquid biopsy, insurance coverage, and the potential need for germline genetics follow-up because of incidental findings.

This PDSA cycle reveals key gaps and opportunities for improvement in patient education before TGT.

Supported by National Institutes of Health (NIH) Grant No. 1R21CA259985 (L.S., S.R.H., H.H., A.E.T., C.J.P., D.G.S.), P30CA016058 (T.S., A.E.T.), UH2CA239105 (D.G.S.), 1R01 CA215151 (A.E.T.), The project described was supported by Award No. UL1TR002733 from the National Center for Advancing Translational Sciences.

Conception and design: Leigha Senter, Marcy Haynam, Elizabeth J. Adams, Heather Hampel, Amanda E. Toland, Carolyn J. Presley, Tasleem J. Padamsee, Daniel G. Stover

Administrative support: Deloris Veney, Marcy Haynam

Provision of study materials or patients: Deloris Veney, Carolyn J. Presley

Collection and assembly of data: Leigha Senter, Taylor Surplus, Elizabeth J. Adams, Daniel G. Stover

Data analysis and interpretation: Leigha Senter, Deloris Veney, Heather Hampel, Carolyn J. Presley, Clara N. Lee, Shelly R. Hovick, Daniel G. Stover

Manuscript writing: All authors

Final approval of manuscript: All authors

Accountable for all aspects of the work: All authors

AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

Patient Understanding of Tumor Genomic Testing: A Quality Improvement Effort

The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated unless otherwise noted. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/op/authors/author-center.

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Leigha Senter

Consulting or Advisory Role: AstraZeneca/Merck, GlaxoSmithKline

Speakers' Bureau: AstraZeneca/Merck

Heather Hampel

Stock and Other Ownership Interests: Genome Medical, GI OnDemand

Consulting or Advisory Role: InVitae, Genome Medical, Promega, 23andMe, GI OnDemand, Natera

Carolyn J. Presley

Consulting or Advisory Role: PotentiaMetrics, Onc Live

Daniel G. Stover

Consulting or Advisory Role: Novartis

No other potential conflicts of interest were reported.