背景:对于越来越多的具有潜在遗传病因的疾病,建议进行生殖系基因检测,其结果会影响医疗管理。然而,由于系统的原因,基因检测在诊所中没有得到充分利用,临床医生,和患者水平的障碍。行为经济学提供了一个框架来创建实施策略,比如轻推,解决这些多层次的障碍,并增加对结果影响医疗管理的条件的基因检测的吸收。
方法:将使用电子表型算法鉴定符合一组条件的种系基因测试资格的患者。一个务实的,3型混合聚类随机化研究将测试对患者和/或临床医生的推动,或者都不是。接受轻推的临床医生将被提示将患者转介给遗传学或自己进行基因检测。我们将使用由临床医生和患者经验告知的快速循环方法,健康公平,和行为经济学在试验开始前优化这些推动。主要实施结果是对预先选择的健康状况进行种系遗传检测。通过电子健康记录收集的患者数据(例如,地理编码地址)将被视为轻推效应的调节者。
结论:这项研究将是首批随机试验之一,旨在研究行为经济学中患者和临床医生指导的轻推对基因检测吸收的影响。务实的设计将有助于大量和多样化的患者样本,允许评估基因检测的吸收,并提供不同轻推组合效果的比较。该试验还涉及优化患者识别,测试选择,ordering,以及基于电子健康记录的基础设施中的结果报告,以进一步解决临床医生水平的利用基因组医学的障碍。这些发现可能有助于确定低成本的影响,可持续实施战略,可纳入卫生保健系统,以改善基因组医学的使用。
背景:ClinicalTrials.gov.NCT06377033。2024年3月31日注册。https://clinicaltrials.gov/study/NCT06377033?term=NCT06377033&rank=1.
BACKGROUND: Germline genetic testing is recommended for an increasing number of conditions with underlying genetic etiologies, the results of which impact medical management. However, genetic testing is underutilized in clinics due to system, clinician, and patient level barriers. Behavioral economics provides a framework to create implementation strategies, such as nudges, to address these multi-level barriers and increase the uptake of genetic testing for conditions where the results impact medical management.
METHODS: Patients meeting eligibility for germline genetic testing for a group of conditions will be identified using electronic phenotyping algorithms. A pragmatic, type 3 hybrid cluster randomization study will test nudges to patients and/or clinicians, or neither. Clinicians who receive nudges will be prompted to either refer their patient to genetics or order genetic testing themselves. We will use rapid cycle approaches informed by clinician and patient experiences, health equity, and behavioral economics to optimize these nudges before trial initiation. The primary implementation outcome is uptake of germline genetic testing for the pre-selected health conditions. Patient data collected through the electronic health record (e.g. demographics, geocoded address) will be examined as moderators of the effect of nudges.
CONCLUSIONS: This study will be one of the first randomized trials to examine the effects of patient- and clinician-directed nudges informed by behavioral economics on uptake of genetic testing. The pragmatic design will facilitate a large and diverse patient sample, allow for the assessment of genetic testing uptake, and provide comparison of the effect of different nudge combinations. This trial also involves optimization of patient identification, test selection, ordering, and result reporting in an electronic health record-based infrastructure to further address clinician-level barriers to utilizing genomic medicine. The findings may help determine the impact of low-cost, sustainable implementation strategies that can be integrated into health care systems to improve the use of genomic medicine.
BACKGROUND: ClinicalTrials.gov. NCT06377033. Registered on March 31, 2024. https://clinicaltrials.gov/study/NCT06377033?term=NCT06377033&rank=1.