Interactive or static reports to guide clinical interpretation of cancer genomics

Abstract

Objective: Misinterpretation of complex genomic data presents a major challenge in the implementation of precision oncology. We sought to determine whether interactive genomic reports with embedded clinician education and optimized data visualization improved genomic data interpretation.

Materials and methods: We conducted a randomized, vignette-based survey study to determine whether exposure to interactive reports for a somatic gene panel, as compared to static reports, improves physicians' genomic comprehension and report-related satisfaction (overall scores calculated across 3 vignettes, range 0-18 and 1-4, respectively, higher score corresponding with improved endpoints).

Results: One hundred and five physicians at a tertiary cancer center participated (29% participation rate): 67% medical, 20% pediatric, 7% radiation, and 7% surgical oncology; 37% female. Prior to viewing the case-based vignettes, 34% of the physicians reported difficulty making treatment recommendations based on the standard static report. After vignette/report exposure, physicians' overall comprehension scores did not differ by report type (mean score: interactive 11.6 vs static 10.5, difference = 1.1, 95% CI, -0.3, 2.5, P = .13). However, physicians exposed to the interactive report were more likely to correctly assess sequencing quality (P < .001) and understand when reports needed to be interpreted with caution (eg, low tumor purity; P = .02). Overall satisfaction scores were higher in the interactive group (mean score 2.5 vs 2.1, difference = 0.4, 95% CI, 0.2-0.7, P = .001).

Discussion and conclusion: Interactive genomic reports may improve physicians' ability to accurately assess genomic data and increase report-related satisfaction. Additional research in users' genomic needs and efforts to integrate interactive reports into electronic health records may facilitate the implementation of precision oncology.

Figure 1.

Physicians' reasons for not using genomic test results to inform treatment recommendations. Categories of responses are described in the figure.

Figure 2.

Physicians’ comprehension scores. (A) Overall: This score is defined as the sum of the correct responses to 18 items (6 items for each of the 3 vignettes; range 0–18). (B) Domain-specific: This score is defined as the sum of the correct responses to the domain-specific items from each of the 3 vignettes (range 0–3). Std: standard report; Int: interactive report. Higher scores correspond to better comprehension.

Figure 3.

Physicians’ average satisfaction score. Responses to 16 items were scored on a 1–4 point Likert scale, with higher scores representing greater satisfaction. The overall satisfaction score was defined as the average of the 16 items.

Figure 4.

Physicians’ attitudes about provider genomic support that would be helpful. Categories of responses are described in the figure.