Lost in the referral loop: Improving completion of cancer genetics referrals through targeted patient outreach.

Abstract

e23298 Background: As awareness of the clinical value of cancer genetic testing increases, combined with reduced costs and expanded access, referrals to cancer genetics programs have and will continue to rise. However, many referred patients do not complete genetic counseling or testing. We evaluated the Tracking Referrals and Adherence to Cancer Evaluation (TRACE) initiative, a quality improvement program designed to improve completion of cancer genetics referrals. Methods: TRACE was implemented at an urban academic medical center to address incomplete referrals to a cancer genetics program. Five hundred consecutive patients who had been referred for cancer risk assessment but had not scheduled an appointment were identified. Patients were contacted via electronic health record (EHR) portal messaging and telephone, with up to three outreach attempts. A portal message was sent with information about the cancer genetics program, followed by two calls. If not reached, patients were left a voicemail with the program’s contact information. When reached, patients were reminded of their referral, asked about barriers to scheduling, and offered assistance with appointment scheduling (in-person and virtual options). Results: Five hundred patients were identified as being referred to the genetics program between September 2024 and May 2025. Among this group, the median age was 42 years; 286 (57.2%) identified as White, 47 (9.4%) as Asian, 32 (6.4%) as Black, 41 (8.2%) as other, and 96 (19.2%) unknown. Thirty-eight (7.6%) patients identified as Hispanic ethnicity. Ninety-five patients (19.0%) had a prior history of cancer. Of the 500 patients contacted, 307 (61.4%) were successfully reached via portal messaging and/or telephone, and a total of 140 patients (45.6%) scheduled a genetics appointment following TRACE outreach. Of the 156 patients (31.2%) who declined to schedule, the commonly cited reasons were time constraints (58, 37.2%) and lack of interest (47, 30.1%), frequently driven by anxiety about genetic results or limited understanding of genetic testing. Conclusions: Targeted post-referral outreach through portal messaging and telephone contact considerably improves completion of cancer genetics referrals. The TRACE initiative demonstrates that additional follow-up can result in scheduled genetics appointments for more than 45% of successfully contacted referred patients who would otherwise not engage in care. Health systems should consider implementing structured reminders and outreach algorithms to reduce referral attrition and improve access to hereditary cancer risk assessment. Patient demographics. N (%) Age (median, range) 42 years (18-89) Race White 286 (57.2%) Asian 47 (9.4%) Black 32 (6.4%) Other 41 (8.2%) Unknown 96 (19.2%) Insurance Commercial/Private 425 (85.0%) Medicare/Medicaid 68 (13.6%) Uninsured/Other 7 (1.4%)