Implementing Timely Germline Genetic Testing for Patients With Pancreatic Cancer Using a Genetics Copilot for Point-of-Care Education and Health Assessment.

Abstract

Pancreatic ductal adenocarcinoma (PDAC) ranks third in cancer-related deaths. Although national guidelines recommend germline multigene panel testing (MGPT) for all patients with PDAC, only 6%-19% undergo testing, mostly due to under-referral and genetic counselor shortages. We evaluated a coordinator-led and digitally supported workflow designed to increase access to pretest education, improve MGPT uptake, and reduce turnaround time (TAT) for patients newly diagnosed with PDAC at our center. Through the Genetic Information for Treatment Decisions (GIFTD) Initiative, a Genetic Risk Education Coordinator (GREC) served as a liaison between providers, genetic counselors, and patients. Subsequently, we partnered with Nest Genomics to develop the GIFTD Partially Automated Nest Copilot (G-PANC), a digital tool that collects cancer history, delivers genetic education, and assesses MGPT interest before coordinator follow-up. Outcomes included genetic education completion, MGPT uptake, and TAT across sequential phases (baseline, GREC-only, and G-PANC [GREC+ Nest Copilot]). Over 1 year, 354 patients with PDAC were invited to access G-PANC; 73% activated accounts, 80% completed education, and 63% expressed MGPT interest. Among those completing education, 86% engaged with the GREC, and 81% consented to testing, including 15 initially uninterested patients. Of the 127 patients tested, 13% had pathogenic variants. Compared with a baseline/traditional workflow, the GREC-only phase was associated with increased MGPT uptake (43% to 80%) and reduced TAT (54 to 30 days). During the subsequent G-PANC phase, testing uptake remained high (77%) and TAT further decreased to 22 days. A coordinator-led workflow substantially increased MGPT uptake and reduced TAT. Digital education integration was feasible, maintained high testing rates, and reduced TAT. Prospective evaluation will clarify the independent contributions of digital automation.