主流化改善了退伍军人事务部转移性前列腺癌患者生殖系检测的采用，而不会加剧差异。

IF 6.2 1区医学 Q1 GENETICS & HEREDITY

Genetics in Medicine Pub Date : 2025-05-01 DOI:10.1016/j.gim.2025.101383

Maren T. Scheuner , Katherine J. Hoggatt , Paloma Sales , Barbara Lerner , Eva Ferino , Morgan Danowski , Ning Zhang , Colin Purmal , Samuel L. Washington III , Michael M. Goodman , Emily E. Ziegler , Andrea J. Stoddard , Carolyn Menendez , Tori Foote , Kerry Rowe , Gina McWhirter , Michael J. Kelley

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引用次数: 0

摘要

目的：为了提高退伍军人事务部（VA）转移性前列腺癌（mPrCA）患者生殖系检测的采用率，引入新的分娩模式来补充遗传咨询（传统模式）；主流化，肿瘤学家执行测试前/测试后活动，混合模式，肿瘤学家执行知情同意，然后参考遗传学。我们通过分娩模式评估生殖系检测的采用情况。方法：我们对2021年5月3日至2022年11月2日确定的mPrCA患者进行了一项全国性队列研究，随访至2023年5月3日。我们使用Cox比例风险模型评估了患者和医院特征以及进行或完成生殖系检测之间的关系。结果：我们确定了18,623例mPrCA患者。平均年龄为73.9岁（SD 8.3，范围35-102），非西班牙裔白人患者占59.6%，非西班牙裔黑人患者占28.9%。两年内种系试验单的累计发病率为13.7%。非西班牙裔黑人患者比非西班牙裔白人患者更有可能接受生殖系检查(HR, 1.28；95%CI, 1.15-1.41)，但不太可能完成他们的订单(HR, 0.81；95%可信区间0.72 - -0.91)。与非西班牙裔白人患者相比，非西班牙裔黑人患者更有可能完成传统模式下的订单(HR, 1.40；95%CI, 111-1.76)，在混合模型下可能性较小(OR, 0.62；95%CI, 0.50-0.77)，主流模型下无差异。结论：对mPrCA患者进行主流生殖系检测提高了采用率，而不会导致非西班牙裔黑人和白人患者之间的差异。

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Mainstreaming improved adoption of germline testing for Veterans Affairs patients with metastatic prostate cancer without exacerbating disparities

Purpose

To improve germline testing adoption for Veterans Affairs patients with metastatic prostate cancer (mPrCA), new delivery models were introduced to complement genetic consultation (traditional model), including mainstreaming where oncologists perform pre/posttest activities and a hybrid model where oncologists perform informed consent and then refer to genetics. We assessed germline testing adoption by delivery model.

Methods

We conducted a nationwide cohort study of mPrCA patients ascertained from May 3, 2021, to November 2, 2022, with follow-up through May 3, 2023. We assessed associations between patient and facility characteristics and having or completing germline test orders using Cox proportional hazards models.

Results

We identified 18,623 mPrCA patients. The average age was 73.9 years (SD, 8.3; range 35-102) with 59.6% non-Hispanic White and 28.9% non-Hispanic Black patients. The cumulative incidence of germline test orders was 13.7% over 2 years. Non-Hispanic Black patients were more likely than non-Hispanic White patients to have germline test orders (hazard ratio [HR], 1.28; 95% CI, 1.15-1.41) but less likely to complete their orders (HR, 0.81; 95% CI 0.72-0.91). Compared with non-Hispanic White patients, non-Hispanic Black patients were more likely to complete orders under the traditional model (HR, 1.40; 95% CI, 111-1.76), less likely under the hybrid model (HR, 0.62; 95% CI, 0.50-0.77) with no difference under the mainstream model.

Conclusion

Mainstreaming germline testing for mPrCA patients improved adoption without introducing disparities between non-Hispanic Black and White patients.

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来源期刊

Genetics in Medicine 医学-遗传学

CiteScore

15.20

自引率

6.80%

发文量

857

审稿时长

1.3 weeks

期刊介绍： Genetics in Medicine (GIM) is the official journal of the American College of Medical Genetics and Genomics. The journal''s mission is to enhance the knowledge, understanding, and practice of medical genetics and genomics through publications in clinical and laboratory genetics and genomics, including ethical, legal, and social issues as well as public health. GIM encourages research that combats racism, includes diverse populations and is written by authors from diverse and underrepresented backgrounds.