This phase III trial compares the use of a digital chatbot enabled intervention to standard remote genetic services for increasing uptake of genetic counseling and testing among adolescents and young adult (AYA) cancer patients. Genetic testing for cancer predisposition syndromes has become standard evidence-based practice and can inform enhanced screening and risk reducing measures to reduce cancer morbidity and mortality. Despite this, many AYAs are not receiving recommended genetic counseling and testing. Offering remote telehealth services can address access barriers and chatbots and texting interventions could enhance patient outcomes and reduce provider and staff time. The use of a digital chatbot enabled intervention may be equally as effective as standard remote genetic services in AYA cancer patients undergoing genetic testing.
PATIENTS: Age ≥ 18 years and ≤ 39 years at the time of enrollment
PATIENTS: AYA cancer patients and survivors. This includes patients at any stage of diagnosis (e.g., newly diagnosed, in treatment, in survivorship) and a cancer diagnosis (including pediatric cancers) at any age ≤ 39 years old. Given targeted therapies for BRCA+ and microsatellite instability (MSI)-high/Lynch Syndrome patients and benefit to relatives, patients with metastatic cancer are included. Any history of cancer, regardless of being in treatment or not
PATIENTS: Language: In order to complete the mandatory patient-completed measures and receive genetic education and counseling, participants must be able to speak and read English or Spanish
PATIENTS: No known diagnosis of dementia or cognitive impairment. Persons with impaired decision-making capacity are ineligible as they need to be able to understand genetic test results, its implications for the patient and family, and explain genetic test results to their family members
None
Parallel
Telemedicine
Other interventionUndergo telehealth visit with genetic counselor for pretest genetic education
Genetic Testing
Other interventionComplete standard of care genetic testing
Telemedicine
Other interventionUndergo telehealth visit with genetic counselor for disclosure of results
Internet-Based Intervention
Other interventionReceive access to Genetic Journey Chatbot
Educational Intervention
Other interventionComplete digital pre-test genetic education
Patient Navigation
BehavioralUtilize chatbot to answer questions, assess barriers, and provide reminders for next steps during the testing period
Interview
Other interventionComplete interview
Survey Administration
Other interventionAncillary studies
Uptake of genetic counseling
Defined as a binary outcome of whether an adolescent or young adult (AYA) underwent genetic counseling within 6 months post completion of the baseline survey. Will be compared between randomized arms using Cochran-Mantel-Haenszel (CMH) tests stratified by gender and a Bonferroni correction will be applied to control family-wise type I error.
Uptake of genetic testing
Defined as a binary outcome of whether an AYA underwent genetic testing within 6 months post completion of the baseline survey. Will be compared between randomized arms using CMH tests stratified by gender and a Bonferroni correction will be applied to control family-wise type I error.
Knowledge of genetic disease
Obtained from the KnowGene scale. Will be compared using non-inferiority testing with the equivalent of a 0.3 standard deviation (SD) non-inferiority margin. The lower limit of the one-sided 97.5% confidence limit for the difference in means will be compared with the non-inferiority margin and non-inferiority will be concluded if the interval fully lies above -0.3 SD. Longitudinal analyses will include model based analysis using generalized linear models of endpoints over time with link function determined by distribution of the endpoint being modeled and adjusting for baseline patient and disease characteristics.
Test result recall
Measured via the Test Result Recall scale. Will be compared using non-inferiority testing with the equivalent of a 0.3 SD non-inferiority margin. The lower limit of the one-sided 97.5% confidence limit for each secondary endpoint at T2 (the primary time point of interest for the secondary analyses) will be compared with the non-inferiority margin and non-inferiority will be concluded if the interval fully lies above -0.3 SD. Longitudinal analyses will include model based analysis using generalized linear models of endpoints over time with link function determined by distribution of the endpoint being modeled and adjusting for baseline patient and disease characteristics.
Perceptions of genetic disease
Measured via the Perceived Risk scale. Will be compared using non-inferiority testing with the equivalent of a 0.3 SD non-inferiority margin. The lower limit of the one-sided 97.5% confidence limit for the difference in means will be compared with the non-inferiority margin and non-inferiority will be concluded if the interval fully lies above -0.3 SD. Longitudinal analyses will include model based analysis using generalized linear models of endpoints over time with link function determined by distribution of the endpoint being modeled and adjusting for baseline patient and disease characteristics.
Anxiety
Measured via Patient Reported Outcome Measurement Information System (PROMIS) anxiety score. Will be compared using non-inferiority testing with the equivalent of a 0.3 SD non-inferiority margin. The lower limit of the one-sided 97.5% confidence limit for the difference in means will be compared with the non-inferiority margin and non-inferiority will be concluded if the interval fully lies above -0.3 SD. Longitudinal analyses will include model based analysis using generalized linear models of endpoints over time with link function determined by distribution of the endpoint being modeled and adjusting for baseline patient and disease characteristics.
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Alliance for Clinical Trials in Oncology
Lead sponsor
National Cancer Institute (NCI)
Collaborator
