Quality intervention to facilitate clinician-patient discussions of lung cancer biomarker testing at safety net and non safety net centers.
Authors: Trosman Julia R. , Martin Nikki A. , Pasquinelli Mary , Weinberg Frank , Lycan Thomas William , Sacks Ruth Lauren , Woodyard Jennifer , Prescott Kevin , Khosla Paramjeet Grewal , Lile Ashley , Shivakumar Latha , Fish-Steagall Ann Ann , Sorgi Marin , Ravelo Arliene , Weldon Christine B. 
Published: September 2024

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Background:
Biomarker testing is critical for optimal therapy selection in non small cell lung cancer, but it takes time and may delay treatment, causing patient anxiety and dissatisfaction. Patients want to understand the necessity and timing of biomarker testing and therapy decisions, but clinicians find these discussions challenging, especially with lower health literacy patients. As a solution, we deployed 4R Oncology model (4R = Right Info/Care/Patient/Time) at 10 centers (4 safety net, 6 non safety net). Under 4R, clinicians discuss with patients a Care Sequence, a predeveloped care checklist with visual timing of care, emphasizing biomarker testing within the overall care plan. It includes social and supportive care to address Social Determinants of Health (SDOH).
Methods:
Interviews with clinicians to examine whether / how Care Sequence helped discuss the need and timing for biomarker testing with patients, including lower health literacy patients. The cohort of clinicians (N=18) included oncologists, fellows and nurses; 10 worked at safety net centers.
Results:
All clinicians reported that Care Sequence helped explain timing of biomarker testing and the need to wait for results (Table). The majority reported that it helped discussions with lower literacy patients and to train fellows how to discuss these issues and place related referrals. These benefits and most of the rationale were reported at a similar rate by safety net and non safety net clinicians.
Conclusions:
The 4R Care Sequence is a promising quality tool that helps clinicians, including fellows, manage patients’ awareness and expectations for timing of biomarker testing and therapy decisions in lung cancer. The benefits in discussions with lower health literacy patients at both safety net and non safety net centers suggest that 4R can address disparities in patients’ understanding of these complex issues and may reduce anxiety while awaiting treatment.

Does Care Sequence help / rationale
% of all clinicians N=18
% of safety net clinicians n=10
% of non safety net clinicians n=8
P value

Helps Explain Timing of Biomarkers & Decision, Need to Wait for Results
100
100
100
1

- Describes how biomarker testing fits into overall care plan
94
100
88
.4

- Visually depicts timing of testing & treatment decision
83
80
88
1

- Recommends patients to be active preparing for treatment while waiting
78
80
75
1

- As a standard, normalizes timing of results, decisions
56
30
88
.02*

Helps Discuss With Lower Health Literacy Patients
89
90
88
1

- Combines visual timeline & succinct checklist
61
60
63
1

- Uses plain language as possible
39
60
13
.02*

- Helps address SDOH while waiting
72
70
75
1

Helps Train Fellows
92
100
67
.2

- Reminds to order biomarkers, other workup
77
80
67
1

- Helps develop narrative, organize discussion of biomarkers
77
80
67
1

- Prompts to discuss SDOH, refer to related care
62
80
0
.04*

*Statistically significant, p<.05.