Journal of the American Pharmacists Association : JAPhA · 2025
Patient and provider perspectives on the implementation of DPYD testing in oncology care clinics in an academic health system.
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Wittner Victoria, Purcell Jasmine, Cayabyab Mari, Hoffecker Glenda, Kalman Jillian, Teitelbaum Ursina, Schnoll Robert, Rendle Katharine A, Tuteja Sony
Аннотация
BACKGROUND: Pharmacogenomic variants in dihydropyrimidine dehydrogenase (DPYD) are associated with increased risk of severe treatment related adverse events (TRAEs) with standard fluoropyrimidine dosing. Pretreatment testing with preemptive dose reductions in variant carriers can prevent TRAEs. However, testing is not widely implemented, highlighting the need to understand barriers to increase adoption and maintenance.
OBJECTIVES: Guided by the Exploration, Preparation, Implementation, and Sustainment (EPIS) and Consolidated Framework for Implementation Research (CFIR) frameworks, we implemented DPYD testing within gastrointestinal oncology clinics. Our study aimed to collect qualitative data from key stakeholders to identify barriers and facilitators of testing following the initial implementation phase into practice.
METHODS: We conducted key informant interviews and focus groups with oncology clinicians, gastrointestinal oncology patients, and caregivers. Semi-structured interview guides informed by EPIS/CFIR were developed. Purposeful sampling was utilized to identify potential participants. Interviews were recorded and transcribed. Research team notes were used where recordings were unavailable, and rapid qualitative methods were used to summarize findings and complete a priori coded matrices based on the EPIS framework. Barriers and facilitators were extracted and categorized by themes.
RESULTS: From 8/2022 to 3/2025, 20 patients, 4 caregivers, and 26 clinicians from 7 sites participated. Immediately after the implementation phase, clinicians mentioned electronic health record integration of test results, availability of blood-based testing, and improved patient safety as main facilitators while cost, evidence uncertainty, and integration into pre-existing workflows were identified as barriers. After clinical testing was implemented, clinician barriers shifted toward lack of clarity in drug labeling and workflow challenges with early patient identification and timely test ordering. Patients were generally unaware of testing and emphasized education as the key facilitator.
CONCLUSION: Patients, caregivers, and providers were in favor of clinical DPYD testing to prevent fluoropyrimidine TRAEs but identified key barriers that can guide efforts toward scaling and maintenance.
OBJECTIVES: Guided by the Exploration, Preparation, Implementation, and Sustainment (EPIS) and Consolidated Framework for Implementation Research (CFIR) frameworks, we implemented DPYD testing within gastrointestinal oncology clinics. Our study aimed to collect qualitative data from key stakeholders to identify barriers and facilitators of testing following the initial implementation phase into practice.
METHODS: We conducted key informant interviews and focus groups with oncology clinicians, gastrointestinal oncology patients, and caregivers. Semi-structured interview guides informed by EPIS/CFIR were developed. Purposeful sampling was utilized to identify potential participants. Interviews were recorded and transcribed. Research team notes were used where recordings were unavailable, and rapid qualitative methods were used to summarize findings and complete a priori coded matrices based on the EPIS framework. Barriers and facilitators were extracted and categorized by themes.
RESULTS: From 8/2022 to 3/2025, 20 patients, 4 caregivers, and 26 clinicians from 7 sites participated. Immediately after the implementation phase, clinicians mentioned electronic health record integration of test results, availability of blood-based testing, and improved patient safety as main facilitators while cost, evidence uncertainty, and integration into pre-existing workflows were identified as barriers. After clinical testing was implemented, clinician barriers shifted toward lack of clarity in drug labeling and workflow challenges with early patient identification and timely test ordering. Patients were generally unaware of testing and emphasized education as the key facilitator.
CONCLUSION: Patients, caregivers, and providers were in favor of clinical DPYD testing to prevent fluoropyrimidine TRAEs but identified key barriers that can guide efforts toward scaling and maintenance.