Offering phone-based patient navigation to improve receipt of genetic testing for hereditary colorectal cancer: A...

To determine whether offering patients newly diagnosed with colorectal cancer (CRC) access to free, phone-based patient navigation increases rates of referral, counseling, and germline genetic testing relative to usual care.

We conducted a randomized controlled trial in an academic-affiliated health system with an established universal CRC tumor screening program. Over one year, all patients eligible for germline genetic testing were identified and randomized to usual care or an offer of patient navigation. Navigation was designed to address barriers to genetic counseling attendance identified through a needs assessment. We followed a Zelen design, where patients randomized to navigation could choose not to participate, and outcome data were collected passively from the electronic health record. Ad hoc analyses examined predictors of genetic services utilization in the usual care arm.

A total of 85 patients (69 [81%] under age 50 years; 41 [48%] female; and 68 [80%] White) were included in the analyses. Thirty-three percent of participants who were offered patient navigation (n = 43) ever engaged with the intervention. At six months, 65 (76%) participants were referred to genetic counseling, 53 (62%) had participated in counseling, and 47 (55%) had received testing. Rates of genetic service utilization did not differ significantly by arm (Z = -0.45, P = .65; Z = .08, P = .93; Z = -0.34, P = .73, respectively). In usual care, female patients and patients who lived closer to the health system were more often referred to genetic services (χ² = 8.81, P < .01; t = 2.39, P = .02, respectively).

Offering phone-based patient navigation in addition to usual care did not significantly increase the use of genetic services among patients with newly diagnosed CRC in this setting, as only one-third of patients offered navigation pursued it. Low engagement may limit the effectiveness of navigation, supporting efforts to mainstream genetic test delivery after a cancer diagnosis.