The Genetics Navigator: Evaluating a Digital Platform for Genomics Health Services

BACKGROUND: Genetic testing is a catalyst for personalized health. Technologies such as targeted panels and genomic sequencing (GS) are exerting a profound influence on clinical care by ushering personalized medicine into mainstream practice. With substantial improvements in diagnostic performance has come unprecedented demand for genetic testing for a broad range of clinical indications.The volume of testing and complexity of genetic testing analysis places unsustainable pressure on the standard model of care for delivering genetics services, which is heavily dependent on multiple interconnected clinical specialists including medical geneticists, genetic counsellors, clinical laboratory directors, bioinformaticians, and genome analysts based in tertiary care centres. With this increased demand, innovative strategies for increasing capacity and efficiency of genetic service delivery are needed. Our research team has built on our previous preliminary work to develop the Genetics Navigator (GN) to fill this gap. The GN is meant to provide end-to-end support to genomic services and patients who are offered genetic testing. The GN is meant to provide patients with information about genetic testing, help patients make decisions about genetic testing, collect patient history and family history collection before their appointment, and provide genetic test results. The study is interested in comparing the effectiveness of the Genetics Navigator with traditional medical appointments with genetic counsellors and medical geneticists.

RATIONALE: There are limited e-health tools for the delivery of GS. Few e-health tools exist to support the comprehensive delivery of GS and very few have been rigorously evaluated.61 Existing tools target cancer settings,42 education36 or return of results46 but are not integrated to enable a seamless end-to-end patient journey. Consequently, existing tools are limited in scope and scale. Finally, due to the lack of comprehensive e-health tools for GS, little is known about end users' needs for an e-health platform. Understanding end users' needs and requirements are critical to the development of an effective e-health solution for GS health service delivery. Finally, the development of our Genetics Navigator tool represents an innovative strategy to address significant health service delivery barriers and advance the implementation of personalized health by increasing efficiency of genetic service delivery and improving patient experience.

OBJECTIVES AND HYPOTHESIS: Evaluate the effectiveness, cost-effectiveness, and user experience of the Genetics Navigator compared to usual care (standard genetic counselling) with patients and parents of patients receiving genetic testing. Hypothesis: Use of the Genetics Navigator will improve emotional functioning (decrease distress \[primary outcome\], anxiety, and decisional conflict), knowledge, quality of life, patient empowerment, personal utility, and intention to and actual follow through with management recommendations compared to usual care.

METHOD: This is a non-blinded prospective repeated measures randomized controlled superiority trial where we will evaluate the effectiveness and cost-effectiveness of the Genetics Navigator in reducing patient distress compared to usual care. As a part of this trial, patients will receive genetic test results related to a range of clinical indications. A qualitative sub-study will examine user experience.

STUDY POPULATION:

Trial: Adult genetics patients (aged ≥18 years) at Sinai Health System (Sinai) and parents/legal guardians of pediatric patients at the Hospital for Sick Children (SickKids) who are currently eligible to receive clinical genetic testing, as determined by a medical geneticist.

Qualitative Interviews: We will interview a purposive sample of up to 20 adult patients and 20 parents/ legal guardians in each arm within 6 months of completing their participation.

INTERVENTION: Participants in the intervention arm will use the Genetics Navigator to support the delivery of genetic services, including intake, education, pre- and post-test counselling, and physician-generated management recommendations. The Navigator will be supported by consults with genetics professionals via in-person/phone/video-conferencing.

CONTROL:Participants in the control arm will receive their genetic counselling and test results through usual care, which consists of in-person/phone/video-conference consults with genetic counsellors and medical geneticists.

• University of North Carolina Genomic Knowledge Scale (UNC-GKS) [Срок оценки: Assessed at baseline, 2 weeks, 1 month, 6 months and 9 months]
• SURE [Срок оценки: Assessed at 1 month]
• Hospital Anxiety and Depression Scale (HADS) [Срок оценки: Assessed at baseline, 2 weeks, 1 month, 6 months and 9 months]
• The Genomics Outcome Scale (GOS) [Срок оценки: Assessed at 2 weeks, 1 month, 6 months and 9 months]
• 36-item Short Form Survey (SF-36) [Срок оценки: Assessed at baseline, 2 weeks, 1 month, 6 months and 9 months]
• Satisfaction with Decision Making Scale [Срок оценки: Assessed at 1 month]
• Preparation for Decision Making Scale [Срок оценки: Assessed at 1 month]
• Acceptability e-Scale [Срок оценки: Assessed at 2 weeks, 1 month, 6 months and 9 months]
• Digital Health Literacy Scale (DHLS) [Срок оценки: Control: Assessed at baseline; Intervention: Assessed at baseline]
• Frequency of platform use [Срок оценки: Baseline]
• Duration of platform session [Срок оценки: 2 weeks, 6 months and 9 months]
• Answers to platform questions [Срок оценки: Assessed at 2 weeks, 6 months and 9 months]