Background: Genetic counseling and testing can identify individuals at elevated hereditary cancer risk, but access remains uneven. Digital delivery may improve reach, yet disparities in engagement and uptake may persist.
Purpose: This secondary analysis of the Broadening the Reach, Impact, and Delivery of Genetic Services (BRIDGE) randomized controlled trial examined whether chatbot-based versus standard-of-care pretest genetic counseling was associated with genetic test ordering and whether associations differed by race/ethnicity or preferred language.
Methods: De-identified participant-level data from 3,073 adults randomized across two United States health systems were analyzed. Test ordering was measured using electronic health record data. Firth logistic regression estimated associations while addressing sparse outcomes and quasi-complete separation in some engagement groups.
Results: In engagement-adjusted models, chatbot assignment was associated with lower odds of ordering genetic tests than standard-of-care counseling. Across both pathways, progression to a test-request stage was the strongest correlate of ordering. No clear evidence indicated that modality associations differed by race/ethnicity or preferred language, although smaller subgroup estimates were imprecise.
Conclusion: Digital counseling may expand access, but access alone may not ensure completion of clinically meaningful care. Implementation should pair digital delivery with supports that help patients move from information exposure to action.
