A15-08 Bridging the Gap Between Genomic Discovery and Clinical Practice: Barriers and Facilitators to Telomere Length Testing in Interstitial Lung Disease

Rationale Peripheral blood leukocyte telomere length (PBL-TL) is tightly linked to fibrotic interstitial lung diseases (ILDs), informing phenotypes, disease progression, and treatment response. Patients with age-adjusted PBL-TL <10th percentile experience worse outcomes across ILD subtypes. Despite its promise as a clinically available and actionable genomic biomarker, PBL-TL testing is rarely integrated into routine ILD clinical care. The objective of this study is to identify actionable provider-level barriers and facilitators to clinical adoption of PBL-TL testing in ILD using implementation science frameworks. Methods We conducted a mixed-methods study using explanatory sequential data collection. Phase 1 included a national survey of clinicians from the Pulmonary Fibrosis Foundation Care Center Network (PFF-CCN). Phase 2 included surveys and interviews with providers participating in a multi-center pragmatic, observational study of PBL-TL testing in 200 adults with fibrotic ILD. Barriers and facilitators were mapped to two validated frameworks, the Capability, Opportunity, Motivation- Behavior (COM-B) model and Behavior Change Wheel (BCW), to identify intervention functions most suited to promote PBL-TL adoption. Results Among the 75 clinicians surveyed in Phase 1, key facilitators reflected strong motivation and professional identity, including prior experience with PBL-TL testing (84%), recognition of professional responsibility for genetic risk evaluation (72%), and belief in PBL-TL’s diagnostic (84%) and prognostic value (91%). Eighty percent expressed interest in actionable education on how and when to use PBL-TL testing. Primary barriers included cost and reimbursement challenges (77%), limited guidance on indications (72%), workflow inefficiencies (67%), insufficient patient education resources (64%), and uncertainty about clinical interpretation (46%). These barriers clustered within the psychological capability and physical opportunity domains of COM-B. Phase 2 surveys of 15 providers who had recently ordered TL testing demonstrated similar themes in facilitators and barriers and specifically identified lack of clinical guidelines (93%) as an additional barrier. Discussion These findings highlight that ILD providers are willing and motivated to adopt PBL-TL testing, but face modifiable structural and knowledge barriers. Interventions emphasizing education, workflow optimization, and environmental enablement - including clinical guideline development, clinical decision support tools, streamlined ordering and reimbursement pathways, and integrated patient education are essential. Future work that embeds PBL-TL testing into ILD care leveraging these intervention functions represents a critical step toward precision medicine and transforming genomic insights into routine, equitable clinical practice.