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We used the Theoretical Domains Framework to report factors associated with implementation of biomarker testing from clinicians' and patients' perspectives and identify strategies to improve its clinical uptake.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>RESULTS<\/jats:title>\n            <jats:p>We included 77 studies: 47 studies reported factors from clinicians' perspective, 33 studies reported patients' perspective, 23 studies reported implementation strategies, and seven studies evaluated effectiveness of interventions to facilitate implementation and improve uptake. Clinicians reported inconsistent knowledge and skills related to interpreting results of biomarker testing, making treatment recommendations, and communicating findings of uncertainty and its implications for patients. Patients reported gaps in their knowledge about biomarker testing, how it related to treatment, and the research processes. Long turnaround times, lack of coverage by health insurance plans, and logistical constraints also impaired implementation. Concerns associated with inappropriate use of biomarker testing in unvalidated populations, safety and efficacy profiles of the corresponding immuno-oncology agents, lack of access to corresponding trials, and setting potentially unrealistic expectations for patients regarding their prognosis were highlighted. There are scarce data on strategies and interventions to facilitate implementation and improve uptake of biomarker testing. Setting up an institutional tumor board, multidisciplinary team coordination, and formal ongoing education were the most frequently reported strategies to facilitate implementation. Educational interventions were reported to be feasible, acceptable, and increased knowledge.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>CONCLUSION<\/jats:title>\n            <jats:p>This review highlights many factors that are amenable to aid implementation and clinical uptake. However, there is a need to evaluate strategies addressing uncertainties and barriers.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1200\/po-25-00063","type":"journal-article","created":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T19:59:10Z","timestamp":1760039950000},"update-policy":"https:\/\/doi.org\/10.1200\/crossmark","source":"Crossref","is-referenced-by-count":10,"title":["Factors Associated With Implementation of Biomarker Testing and Strategies to Improve Its Clinical Uptake in Cancer Care: Systematic Review Using Theoretical Domains Framework"],"prefix":"10.1200","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5423-7343","authenticated-orcid":true,"given":"Rehana A.","family":"Salam","sequence":"first","affiliation":[{"name":"The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, NSW, Australia"},{"name":"Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9544-9764","authenticated-orcid":true,"given":"Kate L.A.","family":"Dunlop","sequence":"additional","affiliation":[{"name":"The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, NSW, Australia"},{"name":"Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2473-5565","authenticated-orcid":true,"given":"Tuba N.","family":"Gide","sequence":"additional","affiliation":[{"name":"Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia"},{"name":"Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia"},{"name":"Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6750-5244","authenticated-orcid":true,"given":"James","family":"Wilmott","sequence":"additional","affiliation":[{"name":"Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia"},{"name":"Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia"},{"name":"Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9194-4888","authenticated-orcid":true,"given":"Andrea","family":"Smith","sequence":"additional","affiliation":[{"name":"The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, NSW, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5331-6370","authenticated-orcid":true,"given":"Anne E.","family":"Cust","sequence":"additional","affiliation":[{"name":"The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, NSW, Australia"},{"name":"Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"233","reference":[{"key":"e_1_3_6_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ctrv.2020.102019"},{"key":"e_1_3_6_3_2","article-title":"Disparities in biomarker testing and clinical trial enrollment among patients with lung, breast, or colorectal cancers in the United States","author":"Bruno DS","unstructured":"Bruno DS, Hess LM, Li X, et al: Disparities in biomarker testing and clinical trial enrollment among patients with lung, breast, or colorectal cancers in the United States. 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