Access to Genetic Testing in Underserved Patients With Cancer

PRIMARY OBJECTIVES: I. To obtain patient and provider input on the optimal content and format of a new relational agent (RA) intervention ("PERLA") for automated pre-test genetics education. II. To obtain patient feedback on the usability of the English- and Spanish-language PERLAs. III. To determine the acceptability of the newly designed English- and Spanish-language PERLAs among patients with cancer. IV. To evaluate the impact of the English- and Spanish-language PERLAs on the proportion of patients who meet cancer-based genetic testing guidelines who receive genetic test results within 3 months of initiating cancer care. V. To evaluate the potential barriers and facilitators to implementation of PERLA in the clinical setting. OUTLINE: DEVELOPMENT PHASE: Participants attend focus groups and provide feedback on the content, format, and usability of the PERLAs to enable to tailor the design of the intervention. USABILITY PHASE: Participants attend usability testing and provide feedback through cognitive interviews. PILOT TESTING PHASE: Participants evaluate the newly developed PERLAs and provide feedback through focused interviews and structured assessment. INTERVENTION PHASE: Patients are randomized to 1 of 2 arms. ARM A: Patients receive access to PERLA comprising pre-test genetics education and standard post-test provider-based genetic counseling over 20-60 minutes. ARM B: Patients receive access to usual care pre- and post-test provider-based genetic counseling. IMPLEMENTATION PHASE: Participants complete qualitative interviews to evaluate potential barriers and facilitators to implementation of PERLA in the clinic. After completion of study intervention, patients are followed up at 1, 3, and 6 months.