Date of Award

Summer 2023

Project Type


College or School


Degree Name

Master of Science

First Advisor

Pamela Kallmerten

Second Advisor

Kaitlynn Liset


Background: Circulating tumor DNA testing in the oncologic clinic setting is used to detect residual disease and genetic mutations for targeted therapy options.

Local Problem: This quality initiative was developed to standardize circulating tumor DNA kit (ctDNA kit) collection in a rural academic medical cancer center. The use of third-party ctDNA testing kits within the clinic has increased in the last three years to detect genetic markers for targeted therapy.

Methods: The use of a plan-do-study-act framework was utilized to revise the workflow for the ctDNA kit collection process to decrease total collection time and increase staff satisfaction. Intervention: With key stakeholder support a revised workflow was implemented to address the need for ctDNA kit collection process. Test requisition forms and test kits were relocated within the clinic to improve ease of access.

Results: Staff satisfaction increased from a mean of 1.17 pre-intervention to a mean of 2.7 of post-intervention in those surveyed and total collection time decreased from a mean of 37 to a mean of 19 minutes following implementation.

Conclusion: The global aim to reduce total collection time was met and to increase staff satisfaction, however, the specific aim to decrease total collection to 15 minutes was not met. Future implementation cycles could include contractual development with the kit vendors to ensure proper billing and electronic health record integration to improve access to results.

Keywords: quality initiative, ctDNA, circulating tumor DNA, workflow implementation, process development