Patient portal engagement for cancer genetic services linked to prior healthcare interactions in RCTDo you use your patient portal? That history predicts if you will see a genetic counselor

Health services research Published April 8, 2026 Study authors: Zhong Lingzi, Bather Jemar R, Goodman Melody S, Kaiser-Jackson Lauren, Volkmar Molly, Bradshaw Richa… PubMed ↗ DOI ↗ Editorial oversight: Dr. Sofia Müller, MD · Lifespan & Whole-Person Care

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Key Takeaway

Consider that digital outreach for genetics may engage patients already interacting with the system.

This randomized controlled trial enrolled 3,073 primary care patients aged 25-60 years from the University of Utah Health and NYU Langone Health systems who met family history-based criteria for cancer genetic evaluation. The intervention involved sending patient portal messages with a hyperlink to a pretest genetics education chatbot or information about scheduling a standard of care appointment, compared to information about scheduling alone. The primary outcome was opening these messages and beginning genetic services.

Analysis showed that opening patient portal messages was positively associated with the number of previous patient portal logins (average marginal effect [AME] 0.32 at UHealth, 0.33 at NYULH), having a recorded primary care provider (AME 0.15 at NYULH), and more primary care visits in the previous 3 years (AME 0.09 at NYULH). Similarly, beginning pretest genetic services was associated with more previous logins (AME 0.14 at UHealth, 0.18 at NYULH), having a recorded provider (AME 0.08 at NYULH), and more primary care visits (AME 0.07 at NYULH). All reported confidence intervals excluded zero, indicating statistical significance.

Safety and tolerability data were not reported. The study's practice relevance suggests that patients already interacting with the healthcare system may be most likely to respond to digital outreach for genetic services, and that addressing barriers to accessing healthcare and technology may be necessary to increase broader engagement. Key limitations of the study design and potential confounding factors were not detailed in the provided evidence.

Imagine receiving a message in your online patient account about genetic testing for cancer. Would you open it? A new study suggests that your past habits with your healthcare system answer that question. Researchers followed 3,073 patients at University of Utah Health and NYU Langone Health who met family history criteria for genetic evaluation. They sent these patients messages about genetic services and watched who responded.

The results were clear but revealing. Patients who had logged into their portal before, saw their primary care doctor frequently, or had a provider recorded in their file were much more likely to open the message and begin genetic services. The connection was strong and consistent across both hospital systems.

This is not a test of a new drug or a new chatbot; it is a look at real-world access. The study did not report any safety issues because no new treatment was given. The main lesson is that people already engaged with their healthcare system are the ones who respond to these messages. If you or someone you know has trouble using online tools or does not see a regular doctor, they may need extra help to access these life-saving genetic services.

What this means for you:

Past use of your patient portal and seeing a regular doctor makes you more likely to engage with genetic testing messages.

Study Details

Study typeRct

Sample sizen = 1

EvidenceLevel 2

PublishedApr 2026

PMID40497580

View Original Abstract ↓

OBJECTIVE: To examine whether patient sociodemographic and clinical characteristics and prior interactions with the healthcare system were associated with opening patient portal messages related to cancer genetic services and beginning services. STUDY SETTING AND DESIGN: The trial was conducted in the University of Utah Health (UHealth) and NYU Langone Health (NYULH) systems. Between 2020 and 2023, 3073 eligible primary care patients aged 25-60 years meeting family history-based criteria for cancer genetic evaluation were randomized 1:1 to receive a patient portal message with a hyperlink to a pretest genetics education chatbot or information about scheduling a pretest standard of care (SOC) appointment. DATA SOURCES AND ANALYTIC SAMPLE: Primary data were collected. Eligible patients had a primary care visit in the previous 3 years, a patient portal account, no prior cancer diagnosis except nonmelanoma skin cancer, no prior cancer genetic services, and English or Spanish as their preferred language. Multivariable models identified predictors of opening patient portal messages by site and beginning pretest genetic services by site and experimental condition. PRINCIPAL FINDINGS: Number of previous patient portal logins (UHealth average marginal effect [AME]: 0.32; 95% CI: 0.27, 0.38; NYULH AME: 0.33; 95% CI: 0.27, 0.39), having a recorded primary care provider (NYULH AME: 0.15; 95% CI: 0.08, 0.22), and more primary care visits in the previous 3 years (NYULH AME: 0.09; 95% CI: 0.02, 0.16) were associated with opening patient portal messages about genetic services. Number of previous patient portal logins (UHealth AME: 0.14; 95% CI: 0.08, 0.21; NYULH AME: 0.18; 95% CI: 0.12, 0.23), having a recorded primary care provider (NYULH AME: 0.08; 95% CI: 0.01, 0.14), and more primary care visits in the previous 3 years (NYULH AME: 0.07; 95% CI: 0.01, 0.13) were associated with beginning pretest genetic services. Patient sociodemographic and clinical characteristics were not significantly associated with either outcome. CONCLUSIONS: As system-level initiatives aim to reach patients eligible for cancer genetic services, patients already interacting with the healthcare system may be most likely to respond. Addressing barriers to accessing healthcare and technology may increase engagement with genetic services.

Patient portal engagement for cancer genetic services linked to prior healthcare interactions in RCTDo you use your patient portal? That history predicts if you will see a genetic counselor

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