Web-based tools for family cancer history and cancer risk modeling: what are the barriers to successful implementation?

Lin, Jenny Ahsan Muhammad Danyal Badiner Nora Chapman-Davis Eloise Krinsky Hannah Bolouvi Karen Nchako Corbyn Litvin Daniel Cantillo Evelyn Holcomb Kevin Frey Melissa

More than 80% of individuals with hereditary cancer syndromes are unaware of and, therefore, cannot take advantage of strategies for cancer prevention. The COVID-19 pandemic has resulted in a revolution in healthcare clinical workflows, moving away from the face-to-face model and towards digital strategies. Collection of family health history (FHH) and automated generation of disease risk models is a powerful digital tool that can be performed remotely and safely during a pandemic and help identify those at-risk for hereditary cancer syndromes. We aimed to evaluate barriers to completion of a web-based application (WBA) for FHH and cancer risk models (CRM). Patients scheduled for a gynecologic oncology new patient appointment between 9/2019-9/2020 were offered enrollment in a prospective trial randomizing participants to collection of FHH during the office face-to-face physician interview vs FHH collection via WBA at home or in the office (randomized 1:1:1). The WBA included embedded CRMs (BRCAPRO, Claus, Tyrer-Cuzick, Gail, colorectal and endometrial MMRPRO, MELAPRO, and PANCRO). 66 patients were randomized to utilization of the WBA with median age 60 years (range 22-88). 53 (80.3%) accessed the application and 13 (19.7%) did not for the following reasons: Home arm (11) - forgot (3), WBA was confusing (1), technological issues (1), uncertain of family history (1), concerned about privacy (1), unsure (3), lost to follow-up (1);Office arm (2) - insufficient time to complete (2). Among patients accessing the WBA, 28 (52.8%) successfully input all necessary information to compute the CRM. Thirty-five patients (66%) had at least one validation error including seven patients with two errors and one with three errors. Causes of validation errors included: patient not eligible due to age or cancer history (17, 32.1%), incomplete entry of personal health information (13, 24.5%), incomplete entry of relative(s) health information (10, 18.9%) and user error (misunderstanding questions) (4, 7.5%). Fifty-two patients, 98.1% of those who accessed the application, had at least one successfully generated CRM. There was no difference in completion of CRM between patients competing the web-based application at home versus in the office prior to the appointment. [Display omitted] WBA for collection of FHH and generation of CRM are a promising part of the current health care digital revolution;however, as with all new technology, it is critical to assess usability and efficacy. In our study of WBA FHH collection, 20% of patients did not successfully access the WBA and only 27% of patients randomized to the WBA successfully completed all risk models. Barriers include difficulty accessing the application, concern about privacy, incomplete entry of personal and relative information and user error. Design of future health information collection systems must emphasize clear patient instructions on accessing the digital tool and comprehensively completing included questions. [ABSTRACT FROM AUTHOR] Copyright of Gynecologic Oncology is the property of Academic Press Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)