Digital Delivery of Information About Genetic Testing for Breast Cancer

NCT ID: NCT04842799

Last Updated: 2023-05-06

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

1140 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-07-05

Study Completion Date

2023-01-16

Brief Summary

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BRCA-DIRECT is a pragmatic, randomised, non-inferiority evaluation that aims to evaluate whether digital delivery of pre-test information for BRCA-testing in breast cancer patients is non-inferior to current standard practice of 1:1 delivery from a healthcare professional as measured by rate of uptake of the genetic testing.

Detailed Description

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Participants will be recruited via breast clinics in two oncology centres. Patients will be provided with a study pack containing information about the study. If in clinic, the patient can complete an expression of interest form and a saliva/blood sample will be stored until consent to the study is received. The consent form and saliva sample can be completed at home and sent to the study team.

On receipt of a signed study consent form, the local site will confirm the patient's eligibility and enter details required for study conduct onto the BRCA-DIRECT databases.

After 24 hours, the participant will be sent a link to the BRCA-DIRECT study platform interface. This link enables the participant to progress through the study or withdraw if they have changed their mind.

Participants will be randomised 1:1 to receive either:

1. Telephone consultation with a genetic counsellor (standard of care) The telephone consultations will be as per standard practice of the qualified genetic counsellor delivering the pre-test information.
2. Digital delivery of pre-test information via BRCA-DIRECT platform (intervention)

Participants will receive a link to the digital pre-test information. This will consist of text covering:

* Genetics and cancer risk
* Genetics testing
* What will happen if your test is positive
* What will happen if your test is negative
* Implications for insurance

All participants will have access to a Genetic Counsellor hotline at all stages of the process.

For both arms, if a participant decides to proceed with the genetic test they will sign a digital 'BRCA-test consent' form, which will be formatted to BSGM (British Society of Genomic Medicine) standards. All participants will receive a copy of their signed BRCA-test consent form via secure email/post. The participant will have two days following test-consent to reverse the decision to proceed with the BRCA-test. Beyond those two days, the test will proceed.

The laboratory testing is a standard UK NHS (National Health Service) genetic test. This is delivered for both the intervention arm and the standard-of-care arm.

Participants with a negative (normal) genetic test result will be randomised to receive results either digitally, or via telephone consultation with the Genetic Counsellor. Any individuals with a positive result will receive their result by telephone. Following delivery of results, a results letter and copy of the pathology report will be sent to the participant and their medical team.

The participants will be invited to complete Quality of Life questionnaires, a knowledge test and satisfaction survey at various time points throughout the study via the BRCA-DIRECT platform.

Conditions

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Breast Neoplasm Female

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

SEQUENTIAL

Participants are initially randomised 1:1 to receive genetic pre-test information either via the BRCA-DIRECT digital platform or a genetic counselling telephone appointment. Once the participants BRCA-gene test result becomes available, they are then randomised sequentially depending on the result of the genetic test. Participants with a negative (normal) result are randomised to receive this information either via the BRCA-DIRECT digital platform or a genetic counselling telephone appointment. Participants with a positive result will not be randomised and instead will always have a genetic counselling telephone appointment.
Primary Study Purpose

OTHER

Blinding Strategy

NONE

Study Groups

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Digital delivery of genetic pre-test information

Half of participants will be provided with genetic pre-test information via the BRCA-DIRECT digital platform.

Group Type EXPERIMENTAL

Digital Delivery of Pre-Genetic Testing Information via the BRCA-DIRECT Platform

Intervention Type OTHER

Participants will receive a link to the digital pre-test information. This will consist of text covering: Genetics and cancer risk; Genetics testing; What will happen if your test is positive; What will happen if your test is negative; Implications for insurance.

Where relevant, parts of the text will be linked through to additional information, such as insurance advice from the Association of British Insurers. Participants will be able to call a genetic counsellor on the hotline during weekday office hours, should they have any questions or require further information.

Genetic counselling telephone appointment to discuss genetic pre-test information

Half of participants will be provided with genetic pre-test information via the normal standard pathway - a telephone consultation with a Genetic Counsellor.

Group Type NO_INTERVENTION

No interventions assigned to this group

Digital delivery of BRCA-gene testing results

97.5% of participant's with a negative (normal) result will receive their BRCA-gene testing result via the BRCA-DIRECT digital platform.

Group Type EXPERIMENTAL

Digital Delivery of Genetic Test Results via the BRCA-DIRECT Platform

Intervention Type OTHER

Participants will receive a digital message that their results are available. When they click this, they will receive digital notification of their negative (normal) result in short form. Full details will be provided in an individualised letter.

Genetic counselling telephone appointment to discuss BRCA-gene testing results

2.5% of participants with a negative (normal) result and those with positive results will receive their BRCA-gene testing result via the normal standard pathway - a telephone consultation with a Genetic Counsellor.

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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Digital Delivery of Pre-Genetic Testing Information via the BRCA-DIRECT Platform

Participants will receive a link to the digital pre-test information. This will consist of text covering: Genetics and cancer risk; Genetics testing; What will happen if your test is positive; What will happen if your test is negative; Implications for insurance.

Where relevant, parts of the text will be linked through to additional information, such as insurance advice from the Association of British Insurers. Participants will be able to call a genetic counsellor on the hotline during weekday office hours, should they have any questions or require further information.

Intervention Type OTHER

Digital Delivery of Genetic Test Results via the BRCA-DIRECT Platform

Participants will receive a digital message that their results are available. When they click this, they will receive digital notification of their negative (normal) result in short form. Full details will be provided in an individualised letter.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Diagnosis of invasive breast cancer or high-grade ductal carcinoma in situ (DCIS)
* Female
* Aged 18 years or over
* Access to smartphone or email + internet
* Good comprehension of the English Language

Exclusion Criteria

• Previous testing for BRCA1/2
Minimum Eligible Age

18 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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University of Sussex

OTHER

Sponsor Role collaborator

University of Manchester

OTHER

Sponsor Role collaborator

Cancer Research UK

OTHER

Sponsor Role collaborator

Institute of Cancer Research, United Kingdom

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Gareth Evans

Role: PRINCIPAL_INVESTIGATOR

Manchester University NHS Foundation Trust

Angela George

Role: PRINCIPAL_INVESTIGATOR

Royal Marsden NHS Foundation Trust

Locations

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Wythenshawe Hospital

Manchester, England, United Kingdom

Site Status

Royal Marsden Hospital, Chelsea

Chelsea, London, United Kingdom

Site Status

Royal Marsden Hospital, Kingston

Kingston, London, United Kingdom

Site Status

Royal Marsden Hospital, Sutton

Sutton, Surrey, United Kingdom

Site Status

North Manchester General Hospital

Manchester, , United Kingdom

Site Status

Countries

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United Kingdom

References

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Torr B, Jones C, Choi S, Allen S, Kavanaugh G, Hamill M, Garrett A, MacMahon S, Loong L, Reay A, Yuan L, Valganon Petrizan M, Monson K, Perry N, Fallowfield L, Jenkins V, Gold R, Taylor A, Gabe R, Wiggins J, Lucassen A, Manchanda R, Gandhi A, George A, Hubank M, Kemp Z, Evans DG, Bremner S, Turnbull C. A digital pathway for genetic testing in UK NHS patients with cancer: BRCA-DIRECT randomised study internal pilot. J Med Genet. 2022 Dec;59(12):1179-1188. doi: 10.1136/jmg-2022-108655. Epub 2022 Jul 22.

Reference Type BACKGROUND
PMID: 35868849 (View on PubMed)

Torr B, Jones C, Kavanaugh G, Hamill M, Allen S, Choi S, Garrett A, Valganon-Petrizan M, MacMahon S, Yuan L, Way R, Harder H, Gold R, Taylor A, Gabe R, Lucassen A, Manchanda R, Fallowfield L, Jenkins V, Gandhi A, Evans DG, George A, Hubank M, Kemp Z, Bremner S, Turnbull C. BRCA-DIRECT digital pathway for diagnostic germline genetic testing within a UK breast oncology setting: a randomised, non-inferiority trial. Br J Cancer. 2024 Nov;131(9):1506-1515. doi: 10.1038/s41416-024-02832-2. Epub 2024 Oct 1.

Reference Type DERIVED
PMID: 39349619 (View on PubMed)

Provided Documents

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Document Type: Study Protocol and Statistical Analysis Plan

View Document

Related Links

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https://pubmed.ncbi.nlm.nih.gov/35868849/

A digital pathway for genetic testing in UK NHS patients with cancer: BRCA-DIRECT randomised study internal pilot (publication of pilot phase study data for the first 130 participants recruited)

Other Identifiers

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C61296/A29423

Identifier Type: OTHER_GRANT

Identifier Source: secondary_id

47406

Identifier Type: REGISTRY

Identifier Source: secondary_id

CCR5234

Identifier Type: -

Identifier Source: org_study_id

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