Translating Cancer Genetics Care: Digital Tools to Improve Cancer Genetics Risk Assessment for Patients With Limited English Proficiency
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PURPOSE: This study assessed the acceptability of a multilingual, digital cancer genetics risk assessment (CGRA) tool among patients with limited English proficiency at linguistically diverse, urban gynecology clinics. MATERIALS AND METHODS: Patients presenting for gynecology appointments who spoke English, Spanish, or Chinese (Mandarin/Cantonese) were offered at check-in to complete a digital CGRA tool available in their preferred language. A convenience sample of 35 patients was selected per language group. The digital tool used patient-reported personal and family health histories to determine genetic testing eligibility based on National Comprehensive Cancer Network criteria. Primary outcomes were patient interest and completion of the digital tool across language groups. Patient interest in completing genetic testing following completion of the digital tool was not measured. Patient interest and completion of the digital tool were compared based on language, using chi-square test or Fisher's exact test. Multivariable logistic regression analysis was used to explore the effect of language, adjusting for other patient-related factors. RESULTS: Of the 105 patients offered the digital tool, 68 (64.8%) initiated the digital tool, among whom 51 (75.0%) completed it. The median age was 46.0 years (IQR, 37-58 years). No significant differences were found between English-speaking and Spanish-speaking patients (interest: 80.0% v 65.7%, P = .18; completion: 82.1% v 91.3%, P = .44). Chinese-speaking patients were significantly less interested and likely to complete the CGRA compared with English-speaking patients (interest: 48.6% v 80.0%, P < .01; completion: 41.2% v 82.1%, P < .01). No significant difference in interest in using the digital tool was observed between Spanish-speaking and Chinese-speaking patients (65.7% v 48.6%, P = .15). Among those interested, Spanish-speaking patients were significantly more likely to complete the digital tool than Chinese-speaking patients (91.3% v 41.2%, P < .01). CONCLUSION: The digital CGRA tool was acceptable to 65% of patients. Spanish-speaking patients showed similar interest and completion rates as English speakers, whereas Chinese-speaking patients had lower interest and completion rates.