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Peer-reviewedCC BY 4.0JAMA Network Open

Digital and Coaching Interventions for Uptake of Cancer Genetic Testing

  • Sarah Austin1
  • Emerson Delacroix1,2
  • John D. Rice3
  • Erika Koeppe1
  • Elizabeth Rizzo4
  • Erika N. Hanson1
  • Liliana Arida-Moody5
  • Shayna Weiner4
  • Sarah T. Hawley6,7
  • Wendy R. Uhlmann1,8
  • J. Scott Roberts9
  • Versha Pleasant10
4 more authors
  • Katrina R. Ellis2,4,9
  • Jennifer J. Griggs1,11
  • Ken Resnicow12
  • Elena M. Stoffel1
12 affiliations
  1. 1Department of Internal Medicine, University of Michigan, Ann Arbor
  2. 2University of Michigan School of Social Work, Ann Arbor
  3. 3Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor
  4. 4Rogel Cancer Center, University of Michigan, Ann Arbor
  5. 5Vanderbilt University School of Medicine, Nashville, Tennessee
  6. 6Department of Medicine, University of Michigan, Ann Arbor
  7. 7Ann Arbor Veterans Affairs Center for Clinic Management Research, Ann Arbor, Michigan
  8. 8Department of Human Genetics, University of Michigan, Ann Arbor
  9. 9Department of Health Behavior & Health Equity, University of Michigan School of Public Health, Ann Arbor
  10. 10Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor
  11. 11Department of Health Management and Policy, University of Michigan, Ann Arbor
  12. 12Division of Epidemiology & Community Health, University of Minnesota, Minneapolis
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Abstract

Importance: Germline genetic testing (GT) for hereditary cancer risk can inform cancer treatment, screening, and prevention, yet testing rates remain low. Alternative strategies are needed to improve facilitation of GT.

Objective: To compare 2 patient-level interventions to increase uptake of hereditary cancer GT against usual care.

Design, Setting, and Participants: The Michigan Genetic Hereditary Testing (MiGHT) randomized clinical trial analyzed self-reported GT outcome data from participants meeting clinical GT criteria between April 21, 2022, and November 21, 2025. Participants were adults (age ≥18 years) who met national criteria for genetic evaluation and had not previously completed germline GT recruited from oncology, primary care, and gastroenterology practices; research registries; and the general public in Michigan. Data were analyzed from April 30, 2025, to May 1, 2026.

Interventions: Participants were randomized to either telephone-based health coaching, a self-directed digital intervention, or usual care. Both interventions incorporated genetics education and motivational interviewing concepts.

Main Outcomes and Measures: GT uptake was assessed at 6- and 12-month time points. The primary outcome was completion of GT by 6 months. The effects of study group on GT uptake were evaluated using logistic regression, adjusting for cancer history, age, gender, and race.

Results: A total of 793 participants (median [IQR] age, 64 [51-71] years; 458 [57.8%] female) were randomized to health coaching (261 participants), the digital intervention (265 participants), or usual care (267 participants). Overall, 31 participants (4.9%) reported completing GT by the 6-month time point, and 76 participants (9.6%) underwent GT across the 12-month study period. Compared with usual care, participants in the digital intervention group had higher odds of completing GT by 6 months (adjusted odds ratio [AOR], 3.88; 97.5% CI, 1.27-14.80), while those in the health coaching group had higher odds of completing GT by 12 months (AOR, 2.25; 97.5% CI, 1.11-4.77). Participants in the digital intervention group were more likely to express intention to test at 6 months (AOR, 2.36; 95% CI, 1.44-3.93), whereas those in the health coaching group had higher intention at both 6 (AOR, 2.99; 95% CI, 1.83-4.95) and 12 (AOR, 2.29; 95% CI 1.29-4.15) months compared with usual care.

Conclusions and Relevance: In this randomized clinical trial of GT interventions, GT uptake was higher among participants who received the digital or health coaching interventions compared with usual care, although overall testing rates were low. These results underscore the importance of content delivery, motivational messaging, and alternative GT care models.

Trial Registration: ClinicalTrials.gov ID: NCT05162846 .

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Cite

BibTeXRIS
BibTeX
@article{austin2026digital,
  title = {{Digital and Coaching Interventions for Uptake of Cancer Genetic Testing}},
  author = {Sarah Austin and Emerson Delacroix and John D. Rice and Erika Koeppe and Elizabeth Rizzo and Erika N. Hanson and Liliana Arida-Moody and Shayna Weiner and Sarah T. Hawley and Wendy R. Uhlmann and J. Scott Roberts and Versha Pleasant and Katrina R. Ellis and Jennifer J. Griggs and Ken Resnicow and Elena M. Stoffel},
  journal = {JAMA Network Open},
  year = {2026},
  month = oct,
  doi = {10.1001/jamanetworkopen.2026.38274},
  url = {https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2855266},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Digital and Coaching Interventions for Uptake of Cancer Genetic Testing
AU  - Sarah Austin
AU  - Emerson Delacroix
AU  - John D. Rice
AU  - Erika Koeppe
AU  - Elizabeth Rizzo
AU  - Erika N. Hanson
AU  - Liliana Arida-Moody
AU  - Shayna Weiner
AU  - Sarah T. Hawley
AU  - Wendy R. Uhlmann
AU  - J. Scott Roberts
AU  - Versha Pleasant
AU  - Katrina R. Ellis
AU  - Jennifer J. Griggs
AU  - Ken Resnicow
AU  - Elena M. Stoffel
PY  - 2026
DA  - 2026/10/13
JO  - JAMA Network Open
DO  - 10.1001/jamanetworkopen.2026.38274
UR  - https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2855266
AB  - Importance: Germline genetic testing (GT) for hereditary cancer risk can inform cancer treatment, screening, and prevention, yet testing rates remain low. Alternative strategies are needed to improve facilitation of GT.  Objective: To compare 2 patient-level interventions to increase uptake of hereditary cancer GT against usual care.  Design, Setting, and Participants: The Michigan Genetic Hereditary Testing (MiGHT) randomized clinical trial analyzed self-reported GT outcome data from participants meeting clinical GT criteria between April 21, 2022, and November 21, 2025. Participants were adults (age ≥18 years) who met national criteria for genetic evaluation and had not previously completed germline GT recruited from oncology, primary care, and gastroenterology practices; research registries; and the general public in Michigan. Data were analyzed from April 30, 2025, to May 1, 2026.  Interventions: Participants were randomized to either telephone-based health coaching, a self-directed digital intervention, or usual care. Both interventions incorporated genetics education and motivational interviewing concepts.  Main Outcomes and Measures: GT uptake was assessed at 6- and 12-month time points. The primary outcome was completion of GT by 6 months. The effects of study group on GT uptake were evaluated using logistic regression, adjusting for cancer history, age, gender, and race.  Results: A total of 793 participants (median [IQR] age, 64 [51-71] years; 458 [57.8%] female) were randomized to health coaching (261 participants), the digital intervention (265 participants), or usual care (267 participants). Overall, 31 participants (4.9%) reported completing GT by the 6-month time point, and 76 participants (9.6%) underwent GT across the 12-month study period. Compared with usual care, participants in the digital intervention group had higher odds of completing GT by 6 months (adjusted odds ratio [AOR], 3.88; 97.5% CI, 1.27-14.80), while those in the health coaching group had higher odds of completing GT by 12 months (AOR, 2.25; 97.5% CI, 1.11-4.77). Participants in the digital intervention group were more likely to express intention to test at 6 months (AOR, 2.36; 95% CI, 1.44-3.93), whereas those in the health coaching group had higher intention at both 6 (AOR, 2.99; 95% CI, 1.83-4.95) and 12 (AOR, 2.29; 95% CI 1.29-4.15) months compared with usual care.  Conclusions and Relevance: In this randomized clinical trial of GT interventions, GT uptake was higher among participants who received the digital or health coaching interventions compared with usual care, although overall testing rates were low. These results underscore the importance of content delivery, motivational messaging, and alternative GT care models.  Trial Registration: ClinicalTrials.gov ID: NCT05162846 .
SN  - 2574-3805
ER  -