Full Research Project 1: Testing the Efficacy of an eHealth Decision Support Tool to Help Latinx Cancer Patients Make Informed Decisions About Tumor Genomic Testing

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Project Summary Full Research Project 1 – Genomic Testing Testing the Efficacy of an eHealth Decision Support Tool to Help Latinx Cancer Patients Make Informed Decisions About Tumor Genomic Testing TU FCCC: Sarah Bauerle Bass, PhD, MPH (Co-Leader) and Michael Hall, MD, MS (Co-Leader) HC: Tracey A. Revenson, PhD (Co-Leader) and Ana F. Abraído-Lanza, PhD (Latinx Culture Leader) The use of tumor genomic profiling (TGP) to identify potential cancer treatments can also identify secondary hereditary risks the patient was unaware of. ASCO policy mandates communication of TGP risks and elicit patient preferences for managing these types of results. Latinx patients have increased cancer risk and mortality but are especially vulnerable to barriers that would impede optimal decision making about secondary genetic risks, including language and acculturation barriers, access and affordability, deportation risks, medical mistrust and low genetic knowledge. The primary goal of this study is to evaluate the efficacy of an electronic health (eHealth) decision support tool (DST) to increase informed decision making among Latinx patients. This proposal builds on current RCT results of testing an eHealth DST called Gene Pilot with Black cancer patients and formative work with Latinx patients funded by the pilot mechanism of the current U54 Partnership. These studies use innovative commercial marketing methods to address TGP concerns, promote informed decision making, and increase communication with providers about preferences for secondary genetic information. Grounded in the Ottawa Framework, the study will determine the efficacy of a revised DST, Gene PilotLX, compared to traditional decision support. Specific aims are: 1. Revise the Gene Pilot DST to reflect formative work with Latinx cancer patients to incorporate specific cultural values and language needs. We will use formative results and establish Community and Scientific Advisory Boards to revise content to make it culturally-anchored. We will then conduct user testing with 25 Latinx cancer patients; 2. Test the impact of Gene PilotLX in a randomized trial. We will conduct a fully powered RCT with 232 Latinx cancer patients at four oncology sites. Intervention participants will have access to Gene PilotLX via a tablet or personal device; the comparison arm will receive non-targeted education materials about TGP. Primary outcomes include decision preparedness, decisional conflict, and communication of preferences with a doctor. Secondary outcomes include communication of preferences with family and changes in perceptions of TGP. H1: Those in the Gene PilotLX arm will have greater reduced decisional conflict and higher decision preparedness compared to the non-targeted decision aid. H2: Those in the Gene PilotLX arm will report communicating TGP preferences with their oncologist more when compared to the non-targeted information arm; and 3. Determine whether the effects of Gene PilotLX on primary and secondary outcomes are moderated by Latinx cultural values and acculturation. H3: Gene PilotLX will have a larger effect on primary outcomes for those holding stronger values of familismo and those who are more acculturated than those with lower values. The reverse will occur with the Latinx value of fatalismo. Break Systemic Barriers to Inclusion: In line with the U54’s Inclusive Excellence vision, this study addresses systemic barriers by focusing on Latinx-specific challenges to engaging and communicating about TGP, thereby reducing potential cancer health disparities by improving informed decision making in an under-studied population at high risk of cancer.