Improving Rates of Germline <i>BRCA</i> Mutation Testing for Patients With Ovarian Cancer in Vancouver Island, British Columbia, Canada.

Abstract

Despite more than a decade of endorsement from multiple international cancer authorities advocating all women with ovarian cancer be offered germline breast cancer (<i>BRCA</i>) gene testing, British Columbia Cancer Victoria was not meeting this target. A quality improvement project was undertaken with the aim of increasing completed <i>BRCA</i> testing rates for all eligible patients seen at British Columbia Cancer Victoria to > 90% by 1 year from April 2016. A current state analysis was completed, and multiple change ideas were developed, including education of medical oncologists, referral process update, initiating a group consenting seminar, and engagement of a nurse practitioner to lead the seminar. We used a retrospective chart audit from December 2014 to February 2018. On April 15, 2016, we initiated our Plan, Do, Study, Act (PDSA) cycles and completed them on February 28, 2018. We evaluated sustainability through an additional retrospective chart audit from January 2021 to August 2021. Patients with completed germline <i>BRCA</i> genetic testing climbed from an average of 58%-89% per month. Before our project, patients waited on average 243 days (± 214) for their genetic test results. After implementation, patients received results within 118 days (± 98). This was sustained with an average of 83% of patients per month having completed germline <i>BRCA</i> testing almost 3 years after project completion. Our quality improvement initiative resulted in a sustained increase in germline <i>BRCA</i> test completion for eligible patients with ovarian cancer.