Implementing interventions to increase genetic testing for breast cancer among high-risk populations: A systematic review of implementation strategies, outcomes, and gaps.

Abstract

To systematically review the implementation strategies, outcomes, and quality of interventions aimed at increasing the uptake of breast cancer-related genetic testing services among women who are at high-risk. A systematic search was conducted on PubMed, CINAHL, PsycINFO, EMBASE, Cochrane Library, and Campbell Coordinating Group databases from January 2005 to October 2024. Studies were included if they evaluated interventions to increase genetic testing uptake or facilitate decision making about genetic testing. A total of 27 articles were identified, including 18 interventions aimed at supporting the uptake of genetic testing for breast cancer. Half of the interventions evaluated face-to-face counseling, whereas the other half used alternative counseling modalities, such as standardized DVD counseling, tailored written materials, and remote video or telephone counseling. Participant satisfaction was consistently high (≥80%) among most interventions; however, cost analyses suggested time savings with alternative delivery strategies. Nevertheless, feasibility varied according to the delivery mode. Remote video counseling faced some technical challenges, decision aids/patient education materials were partly less engaging, and alternative counseling modalities might provide more limited opportunities to discuss emotional and social concerns. None of the interventions progressed beyond early adoption. Alternative approaches to genetic counseling, such as video- and telephone-based delivery and tailored written materials, show promise in terms of feasibility and acceptability. Future research should adopt more rigorous, framework-guided implementation methods with attention to long-term sustainability, while also promoting greater consistency in terminology to improve transparency and comparability.