Feasibility of Using Patient Navigation to Improve Identification of Hereditary Cancer Syndromes in Newly Diagnosed Colorectal Cancer Patients.

Abstract

Purpose: Using germline genetic testing to identify hereditary cancer syndromes in patients newly diagnosed with colorectal cancer (CRC) carries substantial benefits. We examined the feasibility of using patient navigation, an evidence-based approach to reducing structural barriers to recommended care, to improve test completion by increasing pre-test counseling attendance.

Methods: We conducted key informant interviews with representatives from organizations providing cancer care to CRC patients. Interviews included questions derived from the Consolidated Framework for Implementation Research, which delineates barriers and facilitators to implementing evidence-based practices. We used an inductive-deductive coding approach to identify themes related to program feasibility.

Results: We interviewed nineteen participants across thirteen organizations. Key feasibility barriers included: funding to implement and sustain a navigation program; staffing and supervising the navigator role; health information technology needs; gaining administrators' buy-in; and evolving genetic service delivery models. Participants suggested multiple strategies to address implementation barriers, but most would prefer other approaches to improve genetic test completion over implementing a genomics-focused patient navigation program.

Conclusion: Stakeholders across a range of health care organizations saw limited value in improving identification of hereditary CRC syndromes by implementing a program designed to increase pre-test genetic counseling attendance. The need to scale up genetic testing has shifted interest towards delivery models better integrated in established care pathways, requiring fewer resources, and providing broader reach.