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Service Outcomes for Germline Test Delivery for Patients With Metastatic Prostate Cancer.

Maren T Scheuner1,2,3, Katherine J Hoggatt2,4, Paloma Sales5

  • 1Genomic Medicine Service, Sierra Pacific Network Clinical Resource Hub, San Francisco Veterans Affairs (VA) Health Care System, San Francisco, California.

JAMA Network Open
|February 27, 2026
PubMed
Summary
This summary is machine-generated.

Germline testing for metastatic prostate cancer (mPRCA) shows that embedded and full mainstream models improve care outcomes. The full mainstream model is currently most practical for timely testing, while the embedded model shows promise with workforce expansion.

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Area of Science:

  • Oncology
  • Genetics
  • Health Services Research

Background:

  • Germline testing is crucial for cancer management, enabling targeted treatments and personalized screening.
  • Optimizing germline testing delivery models is essential for improving patient care outcomes.

Purpose of the Study:

  • To compare the service outcomes of different germline testing delivery models in patients with metastatic prostate cancer (mPRCA).
  • To evaluate the impact of varying oncologists' and genetics clinicians' involvement on care quality.

Main Methods:

  • A quality improvement study within the Veterans Health Administration (VHA) from May 2021 to May 2023.
  • Mixed methods analysis including 1964 mPRCA patients and key informant interviews.
  • Comparison of traditional, full mainstream, partial mainstream, and embedded germline testing models.

Main Results:

  • The embedded and full mainstream models demonstrated superior effectiveness, efficiency, and timeliness compared to the traditional model.
  • The full mainstream model showed significant efficiency and timeliness benefits.
  • The partial mainstream model was associated with reduced efficiency and fragmented care, particularly in certain patient groups.

Conclusions:

  • The embedded and full mainstream germline testing models offer significant advantages for mPRCA patient care.
  • The full mainstream model is currently the most practical for ensuring timely germline testing.
  • Expansion of the VHA's genetic workforce could make the embedded model a viable and beneficial option.