Patient and Provider Experiences with Precision Oncology: A Qualitative Descriptive Study at the Department of Veterans Affairs (Preprint)

<sec> <title>UNSTRUCTURED</title> Purpose Precision Oncology (PO) improves and extends lives for cancer patients, but multiple studies have documented under-use in practice. We conducted interviews with providers and patients to identify and characterize barriers and facilitators of PO use in clinical care. Methods: Using a qualitative descriptive approach, we conducted semi-structured interviews with 17 oncology patients and 16 oncology providers from multiple VA sites. Data was analyzed via a team-based coding approach using directed content analysis. Codes were then mapped to The Theoretical Domains Framework (TDF) and Behavior Change Wheel sources of behavior (Capability, Opportunity, Motivation) based on consensus of the study team. Results: The patient sample of 17 male Veterans seen at VA oncology in 2022 was 35% Black Race, and 40% completed education with high school. The 16 interviewed providers all had MD degrees, represented 6 states, were 50% female, and averaged 14 years in current position. A total of 1889 unique statements were identified and categorized into 255 meaningful statement codes. The most frequently cited domain for barriers was Environmental Context and Resources. Examples within this domain included challenges with EHR, sample collection, staffing, and patient transportation. Additional frequently referenced barriers included lack of patient or provider knowledge (Knowledge domain), and inability to prioritize PO in the visit (Memory and Attention domain). Notable facilitators included institutional guidelines, nurse navigators, tumor boards, and other educational interventions. Conclusion: Barriers and facilitators of PO implementation emerged at the patient, provider, and systems levels, all of which map to Capability, Opportunity, and Motivation for PO . Our findings support the design of multi-level interventions that target increased knowledge/education, improved workflow, and ease of communication to enhance PO delivery. </sec>