Cancer genetic counseling and testing is potentially lifesaving for individuals at risk of hereditary cancers. Yet, it is severely underutilized among under-resourced Latinas. There has been limited examination of implementing cancer genetic risk screening—the first step of cancer genetic counseling and testing –via community-based organizations (CBOs) serving Latinas. This project explored multilevel barriers and facilitators to implementing cancer genetic risk screening among four CBOs serving Latinas in the Washington DC-Virginia area. We conducted four focus groups with 26 staff at CBOs that implemented a genetic risk screener from January-September 2021. We employed template analysis and a modified Consolidated Framework for Implementation Research (CFIR)—consisting of CFIR’s original five domains (Process, Intervention, Inner Setting, Outer Setting, Characteristics of Individuals) and CFIR 2.0’s Adapting construct and a lens emphasizing Health Equity across all domains — to identify barriers and facilitators to implementation. CBOs administered the risk screener to 789 Latinas. A prominent Process barrier was not having the optimal data management system for screening. CBO staff preferred the Intervention (i.e. the screener) over previous family history data collection. Adapting the screener to organizational infrastructure and patient-level health literacy and cultural responsiveness barriers were facilitators. Lack of Inner Setting staff time to conduct screening was a barrier. Stronger systems of CBOs’ Outer Setting partnerships facilitated screening. Characteristics of Individuals that promoted GCT screening was CBO staff knowledge, beliefs, and self-efficacy towards risk screening. Provided that key barriers are addressed and facilitators are leveraged during implementation, genetic risk screening may potentially be feasible and acceptable even across heterogeneous CBOs. Future research evaluating feasibility and acceptability of genetic risk screening in CBOs is needed.
Background Lower respiratory tract infections (LRTIs) are a major global health burden, and rapid identification of causative pathogens is crucial for selecting appropriate antimicrobial therapy. Conventional culture requires 24–72 hours and often fails to detect fastidious organisms, viral pathogens, or organisms suppressed by prior antibiotics. The BioFire FilmArray Pneumonia Plus Panel (BFPP) is a rapid multiplex PCR assay that identifies a broad range of bacterial, viral, and antimicrobial resistance targets in about 75 minutes. Methods This narrative review compiles findings from published analytical and clinical studies assessing BFPP performance in adult and pediatric LRTIs. Searches were conducted in PubMed, Google Scholar, and ScienceDirect, excluding unrelated articles. Comparative evaluations with standard culture and other molecular assays focused on detection rates, sensitivity, specificity, turnaround time, and effects on antimicrobial management. Data from a single-center evaluation were also included to illustrate real-world application. Results Across studies, BFPP and similar multiplex PCR platforms significantly increased pathogen detection compared with culture, reporting identification rates of 40–66% versus 20–53% for culture. Gains were greatest for fastidious bacteria and viral co-infections. Sensitivity ranged from 57% to >90%, with specificity generally above 90%. When culture-negative but mPCR-positive results in pre-treated patients were considered true infections, sensitivity approached 98%. BFPP’s detection of ~33 respiratory pathogens and key resistance markers in 75 minutes supports earlier targeted therapy and reduced empirical broad-spectrum use. Conclusion BFPP provides rapid, broad, and clinically meaningful pathogen detection in LRTIs, improving diagnostic accuracy and supporting antimicrobial stewardship when integrated with clinical assessment.
National guidelines recommend genetic counseling and testing (GCT) referral for women at increased risk for Hereditary Breast and Ovarian Cancer (HBOC). Although awareness of genetic risk can guide prevention and treatment, Latinas show low awareness and GCT uptake. Despite the expanded access offered by telephone genetic counseling, testing rates remain lower than with in-person counseling, particularly among minoritized groups. Little is known about barriers to completing at-home saliva testing and accessing risk-management follow-up care for those who test positive. This study extends the CONTIGO study (Phase 1), which aimed to increase awareness of HBOC risk and uptake of GCT among Latina women. In Phase 2, we explored barriers and facilitators to completing genetic testing and risk management follow-up care among Latina women who previously received telephone genetic counseling. From those eligible, every third participant was selected for screening and invited to participate. This study involved a semi-structured interview to explore barriers and facilitators to GCT and follow-up care and the completion of a 5-point Likert scale to assess satisfaction with their decision to pursue testing. Data were analyzed using Rapid Qualitative Analysis. Among 21 participants, 11 (52%) completed genetic testing. All participants were of Latin American origin, with an average age of 41 (SD=8.57); 81% were uninsured. Those who underwent genetic testing reported high satisfaction with their decision (M=5, SD=0; scale 1-5), while those who did not undergo testing reported lower satisfaction and more barriers to testing (M=2.4; SD=1.13). Barriers to testing included concerns about life insurance eligibility, health insurance, administrative burdens (e.g., forms, insurance, mailing), family discouragement, and competing priorities. Facilitators included access to clear and culturally relevant information, a desire to protect family members, knowledge of family cancer history, and motivation to prevent cancer. Among those who completed testing (n=11), five (45%) received a positive result and follow-up recommendations (e.g., increased screenings, preventive surgery). Similar barriers emerged in accessing follow-up care, including language barriers, difficulty understanding the implications of test results, and high treatment costs. However, participants expressed satisfaction with the support of community-based organizations (CBOs) in their care navigation. This study highlights the need to address the barriers that Latina women at risk for HBOC face in accessing GCT and follow-up care. Findings underscore the importance of culturally tailored support and interventions that reduce obstacles to care. Future research should examine the development, implementation, and scalability of culturally tailored interventions such as peer navigation, digital tools, and workshops, along with toolkits co-developed with community-based organizations (CBOs), to support informed decision-making and enhance the uptake of GCT and risk management follow-up in this population. Valeria Gómez, Dariana Sedeño-Delgado, Clara B. Barajas, Karina Knizek, Daniela Grados-Rojas, Kristi Graves, Marc Schwartz, Beth Peshkin, Chiranjeev Dash, Vanessa Sheppard, Paula Cupertino, Pilar Carrera, Geoffrey Curran, Brenda Roig, Nathaly Garces Lenis, Mary Mills, Nancy Valencia-Rojas, Gina Hernandez, Kennya Alvarado, Andrea Bedregal, Abraham Aragones, Alejandra Hurtado de Mendoza. Understanding gaps in genetic testing uptake and risk management follow-up care in Latina women at risk for HBOC [abstract]. In: Proceedings of the 18th AACR Conference on the Science of Cancer Health Disparities; 2025 Sep 18-21; Baltimore, MD. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2025;34(9 Suppl):Abstract nr B076.
Breast cancer is the most commonly diagnosed cancer and the leading cause of cancer death among Latina women. National guidelines recommend genetic counseling and testing (GCT) for patients at-risk of hereditary breast and ovarian cancers (HBOC). Compared to non-Hispanic Whites, Latinas are less likely to receive GCT because of systemic (e.g., healthcare bias) and patient-level barriers (e.g., lack of insurance). Community based organizations (CBOs) play a key role in providing essential healthcare services to underserved communities, including Latina women. CBOs can serve as a bridge to connect underserved Latinas to genetic services. There is a need to develop interventions to streamline awareness, education, and resources for CBOs to refer Latinas at-risk of HBOC to GCT or risk-management care. The purpose of this study was to co-develop a CBO toolkit to implement identification and referral of Latinas at risk of HBOC to GCT and risk-management care in partnership with multiple stakeholders. We conducted a focus group with multiple key stakeholders (N=8), which included patient navigators at partnering CBOs, clinicians, and representatives from local health departments and patient advocacy groups. During the focus group we asked for participants’ about perceived barriers/facilitators for Latinas to access GCT and risk-management care, resources, and suggestions for the CBO toolkit. There were 3 main themes identified: barriers/facilitators to GCT completion, CBO toolkit suggestions, and policy implications. For the toolkit development, results greatly favored the toolkit being in a website format to facilitate accessibility, bilingual in English and Spanish, with extensive resources and educational materials on HBOC and GCT. Visual, and easy to use format with downloadable content was preferred. The development of a CBO toolkit to facilitate navigation of at-risk Latinas to GCT services and risk management follow-up care is an important step to reduce healthcare barriers. Sara Idris, Dariana Sedeño-Delgado, Valeria Gómez, Ruth Noll, Rachel Loia, Sophia Samson, Kristi Graves, Marc Schwartz, Beth Peshkin, Chiranjeev Dash, Vanessa Sheppard, Paula Cupertino, Pilar Carrera, Geoffrey Curran, Brenda Roig, Nathaly Garces Lenis, Mary Mills, Nancy Valencia-Rojas, Gina Hernandez, Kennya Alvarado, Andrea Bedregal, Lisa Schlager, Diane Rose, Abraham Aragones, Alejandra Hurtado de Mendoza. Developing a toolkit for CBOs to enhance education and navigation of Latinas at risk of HBOC to genetic services and risk management care [abstract]. In: Proceedings of the 18th AACR Conference on the Science of Cancer Health Disparities; 2025 Sep 18-21; Baltimore, MD. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2025;34(9 Suppl):Abstract nr B078.
Genetic counseling and testing (GCT) inform cancer management for persons at risk for hereditary breast and ovarian cancer (HBOC). Community-based organizations (CBOs) may play a role in identifying at-risk Latinx individuals to connect them to GCT but data are lacking. Two academic centers and their four CBO partners planned to implement a validated questionnaire for HBOC risk screening ("HBOC risk screening tool"). This study aimed to assess CBO's preferences for HBOC risk screening tools, as well as the barriers and facilitators anticipated for future implementation. Pre-implementation focus groups were conducted with CBO's staff. Discussions centered on current practices to identify and refer at-risk patients. During the discussion, staff were asked to select one out of five validated HBOC risk screening tools to implement and to discuss anticipated barriers/facilitators for implementation. The four focus groups were coded and qualitative analyzed following the Consolidated Framework for Implementation Research (CFIR) and Health Equity domains. All CBOs chose the Family History Screen 7 (FHS-7). Participants (N = 35) highlighted how the FHS-7 was easy to adapt to better fit the target population and changing guidelines. They had positive attitudes toward implementing the screening tool, stressed how the culture of the organization positioned them to reach the target population, and noted barriers in different CFIR domains (e.g., low knowledge about HBOC and GCT referrals; scarce available resources). Participants pointed to barriers related to health equity domains including limited access to GCT and follow-up care for uninsured and underinsured populations, challenges obtaining accurate family history, and immigration-related barriers. CBOs highlighted the importance of partnering with other stakeholders to overcome barriers. Findings emphasize the need to develop multi-level implementation strategies to overcome barriers and leverage facilitators. This study can inform the development of implementation toolkits for CBOs to implement HBOC screening tools to advance health equity.
