Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2023

A study protocol for the P-OMICs-flow: Developing a novel precision medicine clinic to drive integration of research into routine healthcare (#402)

April Morrow 1 , Shuang Liang 1 , Frank Lin 2 3 , Milita Zaheed 3 4 5 6 , Skye McKay 1 , Bridget Douglas 5 , Priscilla Chan 1 , Anna Byrne 1 , Kathryn Leaney 7 , Christine Napier 4 6 , Sandy Middleton 8 , Phyllis Butow 9 , Jane Young 10 , Bonny Parkinson 11 , Mandy Ballinger 4 6 12 , Kathy Tucker 5 13 , David Goldstein 3 14 , David Thomas 4 6 12 , Natalie Taylor 1
  1. School of Population Health, Faculty of Medicine and Health, UNSW, Sydney, NSW, Australia
  2. Kinghorn Centre for Clinical Genomics, Garvan Institute of Medical Research, Sydney
  3. School of Clinical Medicine, UNSW, Sydney, NSW, Australia
  4. Genomic Cancer Medicine Program, Garvan Institute of Medical Research, Sydney, NSW
  5. Hereditary Cancer Clinic, Prince of Wales Hospital, Sydney
  6. Omico, Sydney
  7. Consumer Involvement in Research, Cancer Voices, Sydney, NSW
  8. Nursing Research Institute, Australian Catholic University, Sydney
  9. School of Psychology, University of Sydney, Sydney
  10. School of Public Health, University of Sydney, Sydney
  11. Centre for the Health Economy, Macquarie University, Sydney
  12. Centre of Molecular Oncology, Faculty of Medicine and Health, UNSW, Sydney, NSW, Australia
  13. Prince of Wales Medical School, UNSW, Sydney, NSW, Australia
  14. Department of Medical Oncology, UNSW, Sydney, NSW, Australia

Aims

Genomic diagnostics have accelerated therapeutic and preventative breakthroughs in oncology and cancer genetics. However, implementing genomics-based care (a complex clinical intervention) faces serious care fragmentation and scalability issues due to lacking system support. P-OMICs-flow, a novel model of care purposely designed to coordinate precision medicine in oncology, addresses the fundamental issues caused by the widening knowledge-service gap. This model aims to streamline decision support for referring clinicians, enhance quality of care through multifaceted and patient-centred communications, and improve translational capacity by integrating implementation science and clinical informatics.

Methods

Utilising a Type II Hybrid effectiveness-implementation trial design, the P-OMICs-flow service intervention is the model of care – providing centralised multidisciplinary review to support clinicians in the precision oncology care provision. The implementation intervention is design of a platform – applying evidence-based implementation approaches and Learning Health System principles to enhance feasibility and sustainability. All adult patients across Australia referred to P-OMICs-flow (n = est. 100-300/year between 2023-2026), and healthcare professional stakeholders involved in delivery of precision oncology services (n = est. 600), are eligible to participate.                                                                                                                   

Study phases include: 1) using a mixed-methods approach to inform iterative co-design of an implementation platform for P-OMICs-flow, and a suite of outcome measures to assess clinical, service, implementation, and cost-effectiveness; 2) the delivery of the P-OMICs-flow clinic and implementation platform, and evaluation of the outcome measures designed in Phase 1; and 3) a co-design and feasibility test to enable local adaptations and national roll out of the P-OMICs-flow model.

Conclusion

Simultaneously evaluating the clinical-, service-, implementation-, and cost-effectiveness of this world-first precision medicine model within a routine healthcare setting will provide crucial insights into its potential impact, and inform evidence-based strategies for cost-effective widespread adoption and implementation. Ethics and governance approvals are in place, clinic rollout commenced in June 2023, and Phase 1 data collection is underway.