| Content Provider | Springer Nature : BioMed Central |
|---|---|
| Author | Raper, Anna C. Weathers, Benita L. Drivas, Theodore G. Ellis, Colin A. Kripke, Colleen Morse Oyer, Randall A. Owens, Anjali T. Verma, Anurag Wileyto, Paul E. Wollack, Colin C. Zhou, Wenting Ritchie, Marylyn D. Schnoll, Robert A. Nathanson, Katherine L. |
| Abstract | Background Germline genetic testing is recommended for an increasing number of conditions with underlying genetic etiologies, the results of which impact medical management. However, genetic testing is underutilized in clinics due to system, clinician, and patient level barriers. Behavioral economics provides a framework to create implementation strategies, such as nudges, to address these multi-level barriers and increase the uptake of genetic testing for conditions where the results impact medical management. Methods Patients meeting eligibility for germline genetic testing for a group of conditions will be identified using electronic phenotyping algorithms. A pragmatic, type 3 hybrid cluster randomization study will test nudges to patients and/or clinicians, or neither. Clinicians who receive nudges will be prompted to either refer their patient to genetics or order genetic testing themselves. We will use rapid cycle approaches informed by clinician and patient experiences, health equity, and behavioral economics to optimize these nudges before trial initiation. The primary implementation outcome is uptake of germline genetic testing for the pre-selected health conditions. Patient data collected through the electronic health record (e.g. demographics, geocoded address) will be examined as moderators of the effect of nudges. Discussion This study will be one of the first randomized trials to examine the effects of patient- and clinician-directed nudges informed by behavioral economics on uptake of genetic testing. The pragmatic design will facilitate a large and diverse patient sample, allow for the assessment of genetic testing uptake, and provide comparison of the effect of different nudge combinations. This trial also involves optimization of patient identification, test selection, ordering, and result reporting in an electronic health record-based infrastructure to further address clinician-level barriers to utilizing genomic medicine. The findings may help determine the impact of low-cost, sustainable implementation strategies that can be integrated into health care systems to improve the use of genomic medicine. Trial registration ClinicalTrials.gov. NCT06377033. Registered on March 31, 2024. https://clinicaltrials.gov/study/NCT06377033?term=NCT06377033&rank=1 |
| Related Links | https://implementationscience.biomedcentral.com/counter/pdf/10.1186/s13012-024-01385-5.pdf |
| Ending Page | 15 |
| Page Count | 15 |
| Starting Page | 1 |
| File Format | HTM / HTML |
| ISSN | 17485908 |
| DOI | 10.1186/s13012-024-01385-5 |
| Journal | Implementation Science |
| Issue Number | 1 |
| Volume Number | 19 |
| Language | English |
| Publisher | BioMed Central |
| Publisher Date | 2024-08-19 |
| Access Restriction | Open |
| Subject Keyword | Health Services Research Public Health Health Informatics Health Policy Health Administration Health Promotion and Disease Prevention Genetic testing Behavioral economics Nudges Implementation science Electronic health record Pragmatic Type 3 hybrid cluster randomization trial |
| Content Type | Text |
| Resource Type | Article |
| Subject | Health Policy Public Health, Environmental and Occupational Health Health Informatics |
| Journal Impact Factor | 8.8/2023 |
| 5-Year Journal Impact Factor | 9.2/2023 |
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