System-level interventions to improve genomic testing in metastatic prostate cancer: A real-world quality improvement initiative.

508 Background: Integrating germline and somatic genomic testing into routine care for metastatic Prostate Cancer (mPC) is essential for guiding targeted therapies and assessing hereditary cancer risk. In 2020, NCCN guidelines expanded testing recommendations to all mPC patients; however, uptake remained low, with only 30.8% of mPC patients in Florida receiving appropriate testing by 2022. This study evaluates the impact of Quality Improvement (QI) initiatives at Sylvester Comprehensive Cancer Center (SCCC) on testing uptake and identifies key barriers to implementation. Methods: In May 2024, SCCC collaborated with Florida Society of Clinical Oncology (FLASCO) and Pfizer on a state-wide initiative to address barriers to genomic testing in mPC. A survey, complemented by provider and trainee, was conducted to evaluate testing workflows and identify key gaps, which subsequently informed targeted interventions. A retrospective Electronic Medical Record (EMR) analysis assessed testing rates and reasons for missed testing in newly diagnosed mPC patients. Results: Among survey responders, 83.3% reported difficulty using the EMR for clinical decision making, 50% received unstructured genomic results; 83.3% also faced challenges accessing the results. In response, several QI initiatives, some pre-existing and others launched in 2024, were implemented. These included EMR integration of the Genomics Module and Invitae platform, a centralized genomic registry, and multidisciplinary teams modeled after breast cancer screening efforts to improve awareness, reporting, and clinical prompts. Efforts to onboard additional genomic vendors into the EMR are ongoing. Testing rates improved from 57% in 2022 to 68.6% in 2023 and 74% in 2024; among Hispanic patients, rates approached 76.5% and 80%, respectively. Chart review of untested patients showed 60% had no documented reasons; 33% cited lack of clinical impact, with 1 case each due to incomplete testing, patient refusal, or time constraints. The most reported reasons for not testing were referral to the genetics clinic (69.2%), perceived lack of clinical utility (61.5%), and limited time for counseling and test initiation (46.2%). Conclusions: Targeted system-level interventions, including EMR integration and multidisciplinary engagement, significantly improved genomic testing rates for mPC, particularly among Hispanic patients. However, persistent gaps remain, driven by unclear documentation, perceived lack of clinical utility, and time constraints. Continued efforts to optimize EMR workflows with expanded provider education and awareness programs are essential for sustaining and increasing genomic testing adherence across diverse settings.