OBJECTIVE To use online screening and virtual patient education tools to improve the provision of hereditary cancer risk assessment. METHODS We conducted a prospective, single-arm study in which clinicians at five U.S. community obstetrics and gynecology practices underwent an 8-week observation followed by 3-4 weeks of training on online patient screening and virtual patient education (prerecorded video with or without a genetic counselor phone call) for genetic testing-eligible patients. After a 4-week practice period, hereditary cancer risk assessment and patient education metrics were collected at 8 weeks and compared with preintervention metrics using univariate conditional logistic regression models stratified by site. The primary outcome was the change in genetic testing completion rate. Clinicians and patients were invited to complete a satisfaction survey. RESULTS A total of 5,795 and 5,135 patients were seen before and after the intervention, respectively. The proportion of screened patients meeting testing guidelines increased from 21.6% before the intervention to 28.2% after the intervention (odds ratio [OR] 1.36, 95% CI, 1.26-1.47, P<.001). Guideline-eligible patients were significantly more likely to be offered genetic testing (59.1% vs 89.1%, OR 2.06, 95% CI, 1.87-2.27, P<.001), to submit a sample (32.9% vs 45.0%, OR 1.49, 95% CI, 1.27-1.74, P<.001), and to complete testing (16.0% vs 34.2%, OR 2.38, 95% CI, 2.00-2.83, P<.001). Most clinicians agreed or strongly agreed that the screening tool improved the identification of patients meeting hereditary cancer risk assessment guidelines (92.1%), saved time (64.9%), and was easy to incorporate (68.4%) and that patient education improved their ability to deliver hereditary cancer risk assessment standard of care (84.2%). Most patients agreed or strongly agreed that virtual education helped them understand the purpose (91.7%) and implications (92.6%) of genetic testing. CONCLUSION A guideline-based online patient screening tool and virtual patient education were well received. The online tool enabled identification of significantly more guideline-eligible candidates for hereditary cancer risk assessment, and education improved patients' genetic literacy. Together, these tools ultimately improved the genetic testing completion rate.

中文翻译：

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用于遗传性癌症风险评估和测试的在线筛查和虚拟患者教育。


目的 使用在线筛查和虚拟患者教育工具改善遗传性癌症风险评估的提供。方法 我们进行了一项前瞻性单臂研究，其中五个美国社区妇产科诊所的临床医生接受了为期 8 周的观察，然后对符合基因检测条件的患者进行了 3-4 周的在线患者筛查和虚拟患者教育培训（预先录制的视频，有或没有遗传咨询师电话）。4 周练习期后，在 8 周时收集遗传性癌症风险评估和患者教育指标，并使用按部位分层的单变量条件 logistic 回归模型与干预前指标进行比较。主要结局是基因检测完成率的变化。邀请临床医生和患者完成满意度调查。结果 干预前后共共观察了 5,795 例和 5,135 例患者。符合检测指南的筛查患者比例从干预前的 21.6% 增加到干预后的 28.2% （比值比 [OR] 1.36,95% CI，1.26-1.47，P<.001）。符合指南条件的患者接受基因检测 （59.1% vs 89.1%， OR 2.06， 95% CI， 1.87-2.27， P<.001）、提交样本 （32.9% vs 45.0%， OR 1.49， 95% CI， 1.27-1.74， P<.001） 和完成检测 （16.0% vs 34.2%， OR 2.38， 95% CI， 2.00-2.83， P<.001） 的可能性显著更高。大多数临床医生同意或强烈同意，筛查工具提高了对符合遗传性癌症风险评估指南 （92.1%） 的患者的识别，节省了时间 （64.9%），并且易于纳入 （68）。4%），并且患者教育提高了他们提供遗传性癌症风险评估护理标准的能力 （84.2%）。大多数患者同意或强烈同意虚拟教育帮助他们理解基因检测的目的 （91.7%） 和影响 （92.6%）。结论 基于指南的在线患者筛查工具和虚拟患者教育广受好评。该在线工具能够识别出更多符合指南条件的遗传性癌症风险评估候选人，并且教育提高了患者的遗传素养。这些工具最终提高了基因检测的完成率。