Attitudes and Practices Among Internists Concerning Genetic Testing

Abstract

Many questions remain concerning whether, when, and how physicians order genetic tests, and what factors are involved in their decisions. We surveyed 220 internists from two academic medical centers about their utilization of genetic testing. Rates of genetic utilizations varied widely by disease. Respondents were most likely to have ordered tests for Factor V Leiden (16.8%), followed by Breast/Ovarian Cancer (15.0%). In the past 6 months, 65% had counseled patients on genetic issues, 44% had ordered genetic tests, 38.5% had referred patients to a genetic counselor or geneticist, and 27.5% had received ads from commercial labs for genetic testing. Only 4.5% had tried to hide or disguise genetic information, and <2% have had patients report genetic discrimination. Only 53.4% knew of a geneticist/genetic counselor to whom to refer patients. Most rated their knowledge as very/somewhat poor concerning genetics (73.7%) and guidelines for genetic testing (87.1%). Most felt needs for more training on when to order tests (79%), and how to counsel patients (82%), interpret results (77.3%), and maintain privacy (80.6%). Physicians were more likely to have ordered a genetic test if patients inquired about genetic testing (p<.001), and if physicians had a geneticist/genetic counselor to whom to refer patients (p<.002), had referred patients to a geneticist/genetic counselor in the past 6 months, had more comfort counseling patients about testing (p<.019), counseled patients about genetics, larger practices (p<.032), fewer African-American patients (p<.027), and patients who had reported genetic discrimination (p<.044). In a multiple logistic regression, ordering a genetic test was associated with patients inquiring about testing, having referred patients to a geneticist/genetic counselor and knowing how to order tests., These data suggest that physicians recognize their knowledge deficits, and are interested in training. These findings have important implications for future medical practice, research, and education.

Primary care providers’ cancer genetic testing-related knowledge, attitudes, and communication behaviors: A systematic review and research agenda

“…53 Ten studies examined PCPs' self-reported subjective or perceived knowledge. 33,37,[42][43][44][45]47,50,51,55 Although there was no overlap in measures, studies consistently reported a lack of PCPs' confidence in their genetic testing-related knowledge. For example, in a cross-sectional survey of 1311 family practitioners, 54% were not confident in their knowledge of genetic testing in primary care including testing for breast cancer risk.…”

“…45 In another cross-sectional survey of 1209 Oregon clinicians, 83% of primary care providers and 76% of obstetricians/gynecologists reported that they were Bnot at allô r Bsomewhat^(vs. Bmoderately^or Bvery^) confident in their knowledge of colorectal cancer genetics. 37 Seven studies also evaluated PCPs' knowledge in terms of their comfort level with discussing aspects of cancer genetic testing with patients, 33,40,43,44,46,53,56 with results suggesting that PCPs rarely felt prepared for the task of counseling patients about genetic testing. For example, a survey of 50 obstetricians/ gynecologists found that 74% did not feel comfortable counseling patients about available genetic testing for Lynch syndrome, and 76% did not feel comfortable counseling patients about such testing criteria.…”

“…33,34,[41][42][43][44][45]51,52,55,56 Of these, five studies examined PCPs' views about ethical, legal, or social implications of testing. 33,41,43,44,55 These studies noted varying beliefs about the effect of genetic testing on patients' anxiety.…”

“…33,34,[41][42][43][44][45]51,52,55,56 Of these, five studies examined PCPs' views about ethical, legal, or social implications of testing. 33,41,43,44,55 These studies noted varying beliefs about the effect of genetic testing on patients' anxiety. Specifically, whereas a cross-sectional survey of 351 family practitioners, internists, and obstetrician/gynecologists found that only 14% of respondents believed that information about breast cancer risk creates unnecessary anxiety for many women, 41 a mixed-method assessment of 24 family practitioners, urologists, and urology residents found that 74% of participants were concerned that increased-risk results could unnecessarily increase patient anxiety.…”

“…Specifically, whereas a cross-sectional survey of 351 family practitioners, internists, and obstetrician/gynecologists found that only 14% of respondents believed that information about breast cancer risk creates unnecessary anxiety for many women, 41 a mixed-method assessment of 24 family practitioners, urologists, and urology residents found that 74% of participants were concerned that increased-risk results could unnecessarily increase patient anxiety. 33 Concerns about privacy issues and discrimination were also documented; for instance, a cross-sectional survey of 220 family practitioners and internists found that 27% were Bvery concerned^about genetic privacy, 43 and qualitative data collected from 24 family practitioners, urologists, and urology residents highlighted concerns that test results could put patients at risk for discrimination by insurance companies and employers. 33 Furthermore, a cross-sectional survey featuring a vignette of a hypothetical low-risk patient found that among 284 family physicians, 65% believed that refusing to refer the patient to genetic services would harm the provider-patient relationship.…”