Grant: Project Grant

BACKGROUND: Oncologists are increasingly using genomic sequencing to diagnose and optimize care for their patients, but this test also generates incidental findings (IF) about thousands of other current and future diseases. Guidelines recommend patients choose which IF they wish to receive before their genomes are sequenced. There are limited clinical resources and expertise to counsel patients on the thousands of possible IF; decision aids (DAs) can fill this gap. PRELIMINARY DATA: We produced a DA prototype,www.genomicsadviser.com, to guide patients' selection of IF and evaluated its usability and effectiveness. Participants found the prototype informative, acceptable and intuitive to use but some still required decisional support by a clinician, and clinicians wanted to adapt the categories based on their clinical capabilities. OBJECTIVES: 1. Transform our DA prototype into an adaptable, interactive, patient-centered digital decision support tool that supports clinical scalability. 2. Evaluate the effectiveness of our tool among patients being offered IF. DESIGN: 2 phased mixed methods study. Phase 1- User centered design to transform the tool: 1-Discover patient attributes, key counseling qualities, and end user requirements to create user profiles; and construct user profiles. 2-Design content hierarchy, information flow on various platforms and detailed wireframes. 3-Test usability of the beta version with patients and clinicians. 4-Deliver a fully functional and widely compatible web-based tool. Phase 2 -RCT to evaluate the effectiveness of our tool: Population: Cancer patients offered IF. Intervention: Genomics ADvISER to select IF. Control: Standard genetic counseling (GC) to select IF. Outcomes: Primary: Decisional conflict, knowledge. Secondary: satisfaction, preparation for decision-making, and anxiety. IMPACT: Our patient-centered, adaptable and interactive digital support tool will improve decision quality, reduces consult time and healthcare costs.