Exploring barriers to completing referral appointments for cancer genetic services in a rural state.

83 Background: Genetic counseling and testing promotes awareness and management of hereditary cancer risk. Barriers exist to accessing cancer genetic services, particularly among those with healthcare disparities, i.e., those facing geographic and socioeconomic barriers. These barriers impact not only the ability to obtain a referral but also whether the initial appointment is scheduled and completed. This study explored referrals and what factors were associated with whether appointments were successfully completed in a predominantly rural state (Maine). Methods: Medical records were reviewed for patients referred to the state’s largest health system-based cancer genetic program from 2017 through 2023. We evaluated factors that may be associated with referral completion within 90 days. These included: year of referral, patient factors, clinical factors, and health system factors. Associations were examined using univariate logistic regression models. Results: A total of 11,643 referrals were placed and examined over the period studied. Despite a steady increase in the number of referrals, the percent of referrals that were successfully completed decreased over time (54.04% in 2017 to 51.06% in 2023). Patients with older age and whose primary language was identified as English had greater likelihood of completing the referral (OR = 1.01; p < 0.001 and OR = 3.37; p < 0.001, respectively). Patients living in isolated rural areas and those without insurance were less likely to complete the referral (OR =0.84 and OR 0.61; p < 0.001, respectively). Patients with a cancer diagnosis were almost three times more likely to complete the referral (OR = 2.93; p < 0.001). Referrals scheduled as telemedicine appointments were less likely to be completed (OR =0.63; p < 0.001); and referrals coming from providers within the health system were twice as likely to be completed (OR = 2.15; p < 0.001). Conclusions: Successful completion of referral appointments to cancer genetic services varied by several important patient, clinical, and health system factors. Further multivariate analyses will be conducted. Strategies including language translation, educational materials, and financial assistance might boost the completion rate for structurally vulnerable patients. Systems aimed at streamlining the scheduling process are needed to support all individuals in accessing cancer genetic services, with a focus on those with healthcare disparities.