Factors Associated With Implementation of Biomarker Testing and Strategies to Improve Its Clinical Uptake in Cancer Care: Systematic Review Using Theoretical Domains Framework.

PURPOSE: We aimed to synthesize evidence on factors associated with implementation of biomarker testing and strategies to improve its clinical uptake in cancer care. METHODS: MEDLINE, EMBASE, and CENTRAL databases were searched until July 7, 2024. 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. RESULTS: 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. CONCLUSION: 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.