Beyond the standards: The impact of provider collaboration on referrals to genetic counseling.

person Eric S Fowler City of Hope Atlanta, Chicago and Phoenix, Zion, IL info_outline Eric S Fowler, Laura Moreno, Maurie Markman

Authors person Eric S Fowler City of Hope Atlanta, Chicago and Phoenix, Zion, IL info_outline Eric S Fowler, Laura Moreno, Maurie Markman Organizations City of Hope Atlanta, Chicago and Phoenix, Zion, IL, City of Hope Atlanta, Newnan, GA, Cancer Treatment Centers of America, Part of City of Hope, Boca Raton, FL Abstract Disclosures Research Funding No funding received None. Background: The Commission on Cancer standards require institutions to monitor genetic assessment for a selected cancer site, providing an opportunity to increase referrals to genetic counseling. Genetic counseling, risk assessment, and testing improve patient care, outcomes, and facilitate cascade testing in families. This study investigated how collaboration with referring providers through education, feedback, and ongoing communication impacted referrals to genetic counseling. Methods: Study participants included new patients with colorectal cancer (CRC) diagnosed under age 50 presenting to our institution from July 2021 to September 2022. Patients were excluded if they did not return after initial visits. Baseline and intervention time periods were compared. Interventions to increase referrals included communication with the medical staff through memoranda co-authored by genetic counselors and physician champions, presentations by genetic counselors at tumor board, medical oncology, cancer committee meetings, and emails providing quarterly and final outcomes. Descriptive statistics were utilized to review categorical data, with baseline and intervention referral rates compared with the Pearson Chi-Square Test. Results: 133 patients met referral criteria with ages at diagnosis ranging from 19-49 years old. Mean (and median) patient ages were comparable between baseline and intervention study periods: 42.5 (45) and 43.0 (45), respectively. In the baseline period, 10/32 (31.3%) patients were referred to genetic counseling. In the intervention period, 58/101 (57.4%) patients were referred to genetic counseling representing a 26.1% increase over baseline. The Pearson Chi-Square Test yielded a p-value of 0.01. Referral rates varied by quarter (collaboration/education began in mid-Q2): Q1 - 26.7%, Q2 - 45.8%, Q3 - 77.8%, Q4 - 60.0%, and Q5 - 34.4%. Conclusions: Collaboration and communication with referring providers resulted in statistically and clinically significant increases in referrals to genetic counseling. The increase in referrals was most pronounced immediately after collaboration began and declined by the last quarter. This study highlights the importance of genetics educational initiatives and ongoing communication in the oncology setting, and the need for alternative and more sustainable strategies to maintain and increase referrals to genetic counseling. Referrals to genetic counseling facilitate the provision of cancer screening guidelines for patients and their families, based on genetic test results and personal/family histories, and reinforce the importance of cascade testing where appropriate. Genetics referrals: New patients with CRC < 50. Baseline Intervention Total n (%) Not Referred 22 (68.7) 43 (42.6) 62 (46.6) Referred 10 (31.3) 58 (57.4) 71* (53.4) Total 32 (100.0) 101 (100.0) 133 (100.0) *Three baseline patients were referred during intervention