Sue V. Petzel

Improving referral for genetic risk assessment in ovarian cancer using an electronic medical record system.

Objective We sought to evaluate an electronic referral form to increase referral for genetic risk assessment of women with newly diagnosed epithelial ovarian cancer. Methods A form summarizing referral for genetic counseling for women with ovarian cancer was introduced into the electronic medical record allowing gynecologic oncologists to electronically submit a request for genetic services. Analysis compared patient and provider characteristics for women newly diagnosed with ovarian, fallopian tube, and primary peritoneal cancer referred 1 year before and after introducing the form. All patients were seen in a single fee-for-service university-based cancer center clinic. Results There were 86 newly diagnosed ovarian cancer patients seen before and 83 seen after the introduction of the electronic referral form. Most lived in the metropolitan area and had stage III to IV disease, serous histology, a documented family history, and a treating oncologist who was less than 10 years from completion of fellowship. Postintervention referral rates increased from 17% to 30% (P = 0.053). Factors best predicting referral were whether the patient was seen after the intervention (P = 0.009), resided in the metropolitan area (P = 0.006), and had been identified as at high hereditary risk (P < 0.0001). Sixty percent of the referred patients participated in counseling. There were no differences in baseline characteristics of the referred patients before and after the intervention. Conclusions Referral rates increased with the introduction of an electronic medical record referral form suggesting that streamlining the physician referral process might be effective at increasing referrals for cancer genetic risk assessment.

Designing an Educational Website to Improve Quality of Supportive Oncology Care for Women with Ovarian Cancer: An Expert Usability Review and Analysis.

A broad-based research team developed a Health Insurance Portability and Accountability Act (HIPAA)-compliant educational website for women with ovarian cancer to improve the quality of supportive oncology care. Prior to a randomized clinical trial of the website, initial usability testing was implemented to evaluate the website. The initial review found that 165/247 checklist items had sufficient information to allow for evaluation with the website achieving an overall score of 63%. By category, the lowest scores were for the Home Page, Task Orientation, Page Layout & Visual Design, and Help, Feedback & Error Tolerance. Major issues thought to potentially impede actual usage were prioritized in redevelopment and the second usability review, conducted by the same expert, saw an improvement in scores. Incorporating usability concepts from the start of development, fulfilling the positive expectations of end-users, and identifying the technical and personal factors that optimize use may greatly enhance the usage of health websites.

Computer-assisted instruction for the chronically ill child

A package of four computer-assisted instruction lessons has been developed. These lessons teach elementary principles of nutrition and motivate compliance with those principles for adolescents and pre-adolescents (ages 10 to 16 years) with cystic fibrosis. Nineteen patients at the University of Minnesota Regional Cystic Fibrosis Center used an average of two lessons each. Their self-assessed level of nutrition knowledge before using the lessons was low (slightly less than little knowledge). This self-assessment was not correlated with scores on a nutrition pre-test. On the average, patients reported learning between a medium amount and a good deal from the lessons. However such learning could not be documented through pre/post-test methodology.

A qualitative study of barriers to genetic counseling and potential for mobile technology education among women with ovarian cancer

BackgroundNational guidelines recommend genetic counseling for all ovarian cancer patients because up to 20% of ovarian cancers are thought to be due to hereditary cancer syndromes and effective cancer screening and prevention options exist for at-risk family members. Despite these recommendations, uptake of genetic counselling and testing is low. The goal of this study was to identify barriers to and motivators for receipt of genetic counseling along with preferences regarding potential use of a mobile application to promote genetic counseling.MethodsThree focus groups were conducted including 14 women with a diagnosis of epithelial ovarian, primary peritoneal or fallopian tube cancer. Topics included understanding of genetic counseling, perceived pros and cons, preferences for receiving health information, and familiarity with mobile phone technology. Transcripts were analyzed using standard procedures of qualitative thematic text analysis and descriptive coding techniques.ResultsSix major themes regarding barriers to and motivators of genetic counseling and use of mobile technology in promoting genetic counseling emerged: (1) need for information, (2) relevance, (3) emotional concerns, (4) family concerns, (5) practical concerns, and (6) mobile application considerations.ConclusionsThese data reiterate previously reported barriers to genetic counseling as observed in other populations. Participants were supportive of the use of mobile technology for promoting uptake of genetic counseling.

Abstract DPOC-006: mAGIC – CREATION OF A MOBILE APPLICATION TO INCREASE GENETIC COUNSELING FOR WOMEN WITH OVARIAN CANCER

PURPOSE: Current guidelines published by the National Comprehensive Cancer Network and the Society of Gynecologic Oncology recommend that all women with invasive ovarian, fallopian tube, or primary peritoneal cancers receive genetic risk evaluation by a genetic counselor. Despite recommendations, physicians continue to under–refer and women under–use genetic services. This study developed the Mobile Application for Genetic Information on Cancer (mAGIC) intervention to motivate ovarian cancer survivors to undergo genetic counseling. The overall study objective was to develop and assess the feasibility and effectiveness of a theory–based intervention aimed to encourage ovarian cancer survivors to receive genetic counseling. METHODS: Based on the Precaution Adoption Process Model and the Fogg Behavior Model for Persuasive Design, a multi–step process was used to design a 7–day mobile application intervention delivering daily text and video messaging. Content and formatting was developed by a multi–disciplinary expert team in conjunction with a Community Advisory Board and was based on focus groups with ovarian cancer patients. The final content covered the following topics: genetic counseling, genetic testing, cancer genetics and personal health, cancer genetics and my family, taking care of yourself, and preparing for a genetic counseling appointment. Usability testing was conducted to ensure the intervention was relevant and easy to use. To test the effectiveness of the intervention, a randomized control trial of 104 women with ovarian cancer, who have not previously received genetic counseling, was initiated. Participants were randomized to the mobile app intervention or control (usual care). Regardless of randomization assignment, participants received a phone call from a patient health navigator two weeks following enrollment to determine their intentions, self–efficacy, and communication with family regarding seeking genetic counseling. A three month follow–up survey of all participants measured genetic counseling uptake, stage of readiness, self–efficacy, knowledge, and distress. RESULTS: To date, 45 of 104 women have been randomized; 39 have completed the telephone survey and 10 have completed the three month survey. No interim analyses of the primary outcomes were planned; however participant feedback has been positive. CONCLUSIONS: Despite consensus guidelines recommending the referral of all ovarian, fallopian tube and primary peritoneal cancer patients to genetic counseling, not all patients receive the recommended genetic counseling. This mobile application provides a new tool for disseminating needed information about genetic counseling directly to women with ovarian cancer. Citation Format: Melissa A. Geller, MD, Sue Petzel, PhD, Hee Lee, PhD, Heewon Lee, BA, Kristen Niendorf, MS, Rachel Isaksson Vogel, PhD. mAGIC – CREATION OF A MOBILE APPLICATION TO INCREASE GENETIC COUNSELING FOR WOMEN WITH OVARIAN CANCER [abstract]. In: Proceedings of the 11th Biennial Ovarian Cancer Research Symposium; Sep 12-13, 2016; Seattle, WA. Philadelphia (PA): AACR; Clin Cancer Res 2017;23(11 Suppl):Abstract nr DPOC-006.