Founded at the Abramson Cancer Center at the University of Pennsylvania

Electronic Health Record Nudges to Improve Equitable Genetic Screening in Young-Onset Colorectal Cancer

Young-Onset Colorectal Cancer


Recent years have seen an increase in rates of young-onset colorectal cancer (CRC), a diagnosis of CRC prior to the age of 50. When CRC is diagnosed at this age, it may be an indicator of the presence of a hereditary cancer syndrome. In order to identify the presence of these hereditary cancer syndromes for this population, the National Comprehensive Cancer Network (NCCN) recommends germline genetics evaluations. However, multiple studies have demonstrated racial and socioeconomic disparities not only in the rates of those diagnosed with young-onset CRC but also in rates of genetic screening referrals.

This project leverages behavioral economics to improve referral and uptake of germline genetic evaluations for patients with young-onset CRC. An automated, electronic health record (EHR)-based algorithm identifies patients eligible for screening and notifies their oncology providers of their eligibility for a default genetics referral. Providers can review and cancel the referral, if necessary, before patients are invited to a genetics evaluation accompanied with standard genetic counseling.


This intervention promotes a high-value healthcare practice across five hospitals with a racially and socioeconomically diverse patient population. The project lessens the burden on providers of identifying eligible patients while addressing disparities in genetic screening and increasing guideline-concordant cancer care.


Kelsey Lau-Min, MD; Katharine Nathanson, MD; Steven Joffe, MD, MPH; Katharine Rendle, PhD, MSW, MPH; Nandita Mitra, PhD


ASCO Conquer Cancer YIA


Behavior Change Incentives, Health Equity

Transforming Cancer Care

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