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This study investigated reasons for lower-than-expected uptake of germline genetic testing compared to national guidelines amongst adult patients with cancer, self-reporting clinician recommendation for genetic testing. Cross-sectional survey of 596 patients with a personal history of cancer, responded about their cancer diagnosis, physician recommendation for and status of genetic testing and demographics. Adjusting for potential confounding factors (cancer type, education, income and insurance status) male sex significantly decreased odds of receiving a clinical recommendation for genetic testing (Odds Ratio: 0.06; 95% Confidence Interval: 0.04–0.10). Females, with a diagnosis of breast cancer, were more likely to receive a recommendation than other cancer types (64.8% vs. 90.9%, p < 0.001). Participants who received a physician recommendation were significantly more likely to receive genetic testing (p < 0.001). Clinician recommendation is an important driver of genetic testing, necessitating efforts to increase clinician recommendations, particularly for males and patients with cancers other than breast.

Abstract Background Although most cancers are sporadic, germline genetic variants are implicated in 5–10% of cancer cases. Clinical genetic testing identifies pathogenic germline genetic variants for hereditary cancers. The Michigan Genetic Hereditary Testing (MiGHT) study is a three-arm randomized clinical trial that aims to test the efficacy of two patient-level behavioral interventions on uptake of cancer genetic testing. Methods The two interventions being tested are (1) a virtual genetics navigator and (2) motivational interviewing by genetic health coaches. Eligible participants are adults with a diagnosis of breast, prostate, endometrial, ovarian, colorectal, or pancreatic cancer who meet the National Comprehensive Cancer Network (NCCN) criteria for genetic testing. Participants are recruited through community oncology practices affiliated with the Michigan Oncology Quality Consortium (MOQC) and have used the Family Health History Tool (FHHT) to determine testing eligibility. The recruitment goal is 759 participants, who will be randomized to usual care or to either the virtual genetics navigator or the motivational interviewing intervention arms. The primary outcome will be the proportion of individuals who complete germline genetic testing within 6 months. Discussion This study addresses patient-level factors which are associated with the uptake of genetic testing. The study will test two different intervention approaches, both of which can help address the shortage of genetic counselors and improve access to care. Trial registration This study has been approved by the Institutional Review Board of the University of Michigan Medical School (HUM00192898) and registered in ClinicalTrials.gov (NCT05162846).