Advancing health equity: A qualitative study assessing barriers and facilitators of implementing hereditary breast and ovarian cancer risk screening tools in community‐based organizations

Abstract

Genetic counseling and testing (GCT) inform cancer management for persons at risk for hereditary breast and ovarian cancer (HBOC). Community‐based organizations (CBOs) may play a role in identifying at‐risk Latinx individuals to connect them to GCT but data are lacking. Two academic centers and their four CBO partners planned to implement a validated questionnaire for HBOC risk screening (“HBOC risk screening tool”). This study aimed to assess CBO's preferences for HBOC risk screening tools, as well as the barriers and facilitators anticipated for future implementation. Pre‐implementation focus groups were conducted with CBO's staff. Discussions centered on current practices to identify and refer at‐risk patients. During the discussion, staff were asked to select one out of five validated HBOC risk screening tools to implement and to discuss anticipated barriers/facilitators for implementation. The four focus groups were coded and qualitative analyzed following the Consolidated Framework for Implementation Research (CFIR) and Health Equity domains. All CBOs chose the Family History Screen 7 (FHS‐7). Participants (N = 35) highlighted how the FHS‐7 was easy to adapt to better fit the target population and changing guidelines. They had positive attitudes toward implementing the screening tool, stressed how the culture of the organization positioned them to reach the target population, and noted barriers in different CFIR domains (e.g., low knowledge about HBOC and GCT referrals; scarce available resources). Participants pointed to barriers related to health equity domains including limited access to GCT and follow‐up care for uninsured and underinsured populations, challenges obtaining accurate family history, and immigration‐related barriers. CBOs highlighted the importance of partnering with other stakeholders to overcome barriers. Findings emphasize the need to develop multi‐level implementation strategies to overcome barriers and leverage facilitators. This study can inform the development of implementation toolkits for CBOs to implement HBOC screening tools to advance health equity.

Electronic medical record documentation of germline genetic evaluations in patients with ovarian cancer

“…Other barriers to testing have been described in the literature including access, insurance issues, other socioeconomic characteristics, patient risk perception, psychological well‐being and knowledge about/understanding of genetic testing, and primary care physician discussion of BRCA1/2 testing. It has been demonstrated that racial and ethnic minorities less frequently undergo genetic testing (Armstrong, 2005; Bowen et al, 2023; Chapman‐Davis et al, 2021; Hanson et al, 2023; Hong et al, 2023; Jones et al, 2017; Kurian et al, 2019, 2021). The current report is based on a consecutive population of patients seen as outpatients for ovarian cancer, but notably, the study population does lack diversity and reflects the general underrepresentation of minorities in clinical studies focusing on genetics.…”