{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T03:29:13Z","timestamp":1790998153250,"version":"4.1.0"},"reference-count":55,"publisher":"American Medical Association (AMA)","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Cascade genetic testing (CGT) is a key strategy for cancer prevention in families with hereditary breast and ovarian cancer syndrome (HBOC) and Lynch syndrome (LS), yet uptake among at-risk relatives remains persistently low, particularly in medically underserved populations where structural and informational barriers limit access to genetic services.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To evaluate the feasibility and preliminary effects of IGNITE-TX (Identifying Individuals for Genetic Testing and Treatment), a scalable, bilingual, navigator-supported digital intervention designed to increase CGT uptake among at-risk relatives of individuals with HBOC or LS.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n In this 2\u2009\u00d7\u20092 factorial pilot randomized clinical trial, probands with HBOC or LS self-enrolled online from October 1, 2023, to February 15, 2025, after recruitment through clinical, laboratory, and community pathways across the US and invited their at-risk relatives to participate. Families were cluster-randomized to 4 study arms (1:1:1:1); outcomes were assessed at 6 months.<\/jats:p>\n <\/jats:sec>\n \n Interventions<\/jats:title>\n Usual care with standard printed materials (arm 1); no-cost telegenetic counseling and testing, self-initiated by the at-risk relative (arm 2); IGNITE-TX, comprising proactive family genetic navigator support and access to a bilingual digital education and decision-support platform (arm 3); or IGNITE-TX plus no-cost telegenetic counseling and testing with navigator-assisted access (arm 4).<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Feasibility outcomes were enrollment and survey completion at baseline and 6 months. Secondary outcomes were CGT completion among at-risk relatives, informed decision-making, and readiness along the genetic testing pathway.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n In this pilot randomized clinical trial, 60 probands (median age, 46.5 [range, 20-83] years; 59 female [98.3%]) and 144 at-risk relatives (median age, 39 [range, 18-87] years; 71 female [49.3%]) were enrolled. Among at-risk relatives, 99 (68.8%) reported at least 1 structural barrier to care. A total of 58 probands (97.2%) and 117 at-risk relatives (81.3%) completed the 6-month survey. Among at-risk relatives, 1 of 29 (3.4%) completed CGT in arm 1, 8 of 39 (20.5%) in arm 2, 17 of 30 (56.7%) in arm 3, and 36 of 46 (78.3%) in arm 4. Compared with non\u2013IGNITE-TX arms, at-risk relatives in IGNITE-TX arms showed greater CGT completion (odds ratio, 26.9; 95% CI, 2.4-59.5), informed decision-making (48 of 60 [80.0%] vs 8 of 57 [14.0%];\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001), and readiness to pursue CGT (action stage: 53 of 61 [86.9%] vs 9 of 55 [16.4%];\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this pilot randomized clinical trial, IGNITE-TX was feasible to deliver in a community-recruited cohort with structural barriers to care and was associated with higher CGT completion and improved informed decision-making and readiness compared with non\u2013IGNITE-TX arms. These findings support further evaluation of IGNITE-TX as a scalable navigation model for equitable hereditary cancer care.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n ClinicalTrials.gov Identifier:\n NCT05677048<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2026.30668","type":"journal-article","created":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T15:30:28Z","timestamp":1787844628000},"page":"e2630668","source":"Crossref","is-referenced-by-count":1,"title":["A Multilevel Intervention to Identify Individuals for Genetic Testing and Treatment"],"prefix":"10.1001","volume":"9","author":[{"given":"Kirsten A.","family":"Jorgensen","sequence":"first","affiliation":[{"name":"Vanderbilt University Medical Center, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nuria","family":"Agusti","sequence":"additional","affiliation":[{"name":"Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tara","family":"Coffin","sequence":"additional","affiliation":[{"name":"Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karla","family":"Barajas","sequence":"additional","affiliation":[{"name":"Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria D.","family":"Iniesta","sequence":"additional","affiliation":[{"name":"Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erica M.","family":"Bednar","sequence":"additional","affiliation":[{"name":"Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexa","family":"Kanbergs","sequence":"additional","affiliation":[{"name":"Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roni Nitecki","family":"Wilke","sequence":"additional","affiliation":[{"name":"Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabel","family":"Beshar","sequence":"additional","affiliation":[{"name":"Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Pirzadeh-Miller","sequence":"additional","affiliation":[{"name":"The University of Texas Southwestern Medical Center, Dallas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sayoni","family":"Lahiri","sequence":"additional","affiliation":[{"name":"The University of Texas Southwestern Medical Center, Dallas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathy","family":"Pratt","sequence":"additional","affiliation":[{"name":"The University of Texas Southwestern Medical Center, Dallas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristofer","family":"Jennings","sequence":"additional","affiliation":[{"name":"Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heidy","family":"Bosch","sequence":"additional","affiliation":[{"name":"South Texas Health System, Edinburg"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"III","given":"Charles A.","family":"Leath","sequence":"additional","affiliation":[{"name":"O\u2019Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beth","family":"Karlan","sequence":"additional","affiliation":[{"name":"University of California, Los Angeles"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melissa K.","family":"Frey","sequence":"additional","affiliation":[{"name":"Weill Cornell Medicine, NewYork-Presbyterian, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ravi","family":"Sharaf","sequence":"additional","affiliation":[{"name":"Weill Cornell Medicine, NewYork-Presbyterian, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen","family":"Lu","sequence":"additional","affiliation":[{"name":"H. 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