Improving germline genetic testing and genetic counseling referral in prostate, pancreatic, and colorectal cancer through a multidisciplinary quality improvement intervention.

Abstract

580 Background: Germline testing (GLT) identifies hereditary cancer syndromes and informs precision oncology care. NCCN guidelines recommend genetic evaluation for all patients with pancreatic cancer (Panc), those with high-risk or metastatic prostate cancer (PCa), and select patients with colorectal cancer (CRC). Despite these recommendations GLT and genetics counseling (GC) remains underutilized. We conducted a quality improvement (QI) initiative to to identify barriers to referral patterns and implement interventions to improve guideline-concordant evaluation. Methods: We retrospectively reviewed patients with prostate, pancreatic, or colorectal cancer seen at the University of Arkansas for Medical Sciences between August 2024 and February 2025 who met NCCN criteria for GLT (pre-intervention: Aug 2024-Feb 2025, n=113). We extracted demographics, documented family history (FH), GLT orders/results, and GC referrals, and surveyed providers on perceived barriers. Informed by these data, we embedded GLT discussion into multidisciplinary tumor boards and placed guideline-based materials in physician workrooms. We then screened a post-intervention cohort of NCCN-eligible patients (Aug-Oct 2025, n=61). Proportions were compared with chi-square or Fisher exact tests. Results: At baseline, only 8.8% (10/113) of eligible patients were referred to genetic counseling. Family history of cancer was documented in 46.9% of patients. Among patients undergoing germline testing, 36% had pathogenic or likely pathogenic variants, yet only 55.6% (5/9) were referred to genetic counseling. Providers identified insurance concerns and uncertainty regarding testing as the most common barriers. Following intervention, GC referral rates increased nearly threefold from 8.8% (10/113) to 24.6% (15/61) (p=0.004). Among patients with a documented family history, referral rates increased from 18.9% to 78.6% (p<0.001). All post-intervention germline testing was initiated through genetics clinic referral pathways. Conclusions: A multidisciplinary workflow intervention significantly increased GLT and GC referrals among NCCN-eligible oncology patients. Workflow-based strategies integrating genetics expertise, provider education, and standardized documentation may improve adherence to hereditary cancer evaluation guidelines and expand access to GC services. Characteristics of NCCN-eligible patients and genetic counseling referral outcomes before and after intervention. Outcome Pre (n=113) Post (n=61) P Genetic counseling referral 10 (8.8%) 15 (24.6%) 0.004 Referral among FH+ patients 10/53 (18.9%) 11/14 (78.6%) <0.001