Exploring patient and clinician perspectives for homologous recombination deficient (HRD) biomarker testing to guide precision medicine for advanced ovarian cancer treatment: A qualitative study.

Objective

To explore the knowledge, attitudes, and experiences of advanced ovarian cancer patients and clinicians regarding homologous recombination deficiency (HRD) testing in Canada to offer a more comprehensive understanding of the real-world implications of HRD testing, and help improve patient-informed decision-making practices.

Methods

We conducted pan-Canadian one-to-one, semi-structured interviews with patients with advanced high grade serous ovarian cancer (HGSOC) and clinicians (i.e. oncologists providing direct treatment for patients with HGSOC). The interview topic guide was co-developed with patient research partners, guided by an earlier narrative review, and explored knowledge of HRD testing, experiences interpreting and understanding test results, barriers and facilitators, and suggestions for test implementation. Interviews were transcribed and thematically analyzed to identify patterns among participant groups.

Results

Interviews were conducted with patients (n = 20) and clinicians (n = 12) across seven Canadian provinces. HRD testing was viewed positively to guide treatment decisions. Facilitators included use of existing biopsied tumours, no out-of-pocket costs, and streamlined diagnostic processes. Clinicians desired reflex, in-house testing for efficient and timely decisions. Understandings of HRD results were enhanced by trust and communication between patients and clinicians. However, preferences towards treatment options sometimes affected use of HRD results, such as clinicians' bias towards specific poly (ADP-ribose) polymerase inhibitors (PARPis) and patients' prioritization of quantity versus quality of life. Both groups expressed desire for educational resources to aid test result interpretation and guide informed treatment decision-making.

Conclusions

HRD testing is critical to inform patients' maintenance therapy treatment options. Increasing awareness and equitable access to HRD testing across Canada will improve informed patient decision-making and health outcomes. PRACTICE IMPLICATIONS Findings will inform strategies to enhance patient-centred care, such as communication tools and guidelines, enhanced shared-decision making between patients and clinicians, and standardized nationwide HRD testing processes.