Examining barriers and facilitators to multi-cancer early detection test buy-in in Alabama.

168 Background: Multi-cancer early detection (MCED) tests are a novel approach to cancer screening, offering the potential to detect multiple cancers through a single blood draw. This study aimed to explore the barriers and facilitators to the adoption of MCED tests in Alabama, a state with prevalent health inequities, and to develop a communication tool to support informed decision-making. Methods: This qualitative study, conducted January-August 2024, utilized semi-structured interviews of primary care patients and caregivers of cancer patients from the University of Alabama at Birmingham to explore knowledge, perceptions, and behaviors on barriers and facilitators to MCED testing. Using a grounded theory approach, interviews were analyzed through iterative coding to identify themes, examining barriers and facilitators to adoption of MCED testing. The findings informed the development of a communication tool designed to support informed decision-making about MCED testing. Results: Of 20 interviewed participants, median age was 53 years (IQR 41-68), 11 (55%) were male, 15 (75%) were White, 70% were partnered, and 95% had some college education. Participants expressed a strong interest in the early cancer detection aspect of MCED testing, citing benefits such as improved health outcomes, mental comfort, and sense of empowerment related to their healthcare. Conversely, patients raised concerns about unnecessary diagnoses, and distress over result ambiguity, test accuracy, cost, and limited clinical validation of MCED testing. These insights guided the development of a communication tool addressing test accuracy and reliability, scope of testing, emotional implications, costs and insurance, follow-up care, and privacy concerns to facilitate informed decision-making. An interdisciplinary team consisting of a medical anthropologist, a primary care physician, a hematological oncologist, a gynecological oncologist and a public health expert, generated a communication tool. Conclusions: Overall, MCED screening was perceived as promising for ease of use, and early-detection of cancer. However, adoption requires addressing emotional, financial, and logistical barriers. The communication tool, informed by participant insights, aims to support patient-provider discussions. Future research should evaluate its effectiveness across diverse populations to guide informed discussions and promote equitable integration of MCED screening into clinical practice.