Confidence of primary care physicians in their ability to carry out basic medical genetic tasks—a European survey in five countries—Part 1

Abstract

Western health care systems are facing today increasing movement of genetic knowledge from research labs into clinical practice. This paper reports the results of a survey that addressed the confidence of primary care physicians in their ability to carry out basic medical genetic tasks. The survey was conducted in five countries (France, Germany, The Netherlands, Sweden and the UK). Stratified random samples were drawn from primary care physicians in the five countries representing a sampling frame of 139,579 physicians. Stepwise binary logistic regression procedures were performed to identify the predictor variables for self-reported confidence. Three thousand six hundred eighty-six physicians participated and filled out a self-administered questionnaire. The margin of error for accurate representation of each group of European general practitioners and specialists in the total sample is 2.9% for GP, 2.8% for obstetricians/gynaecologists (OB/GYN) and for paediatricians (PAED) 2.6% (95% confidence level). Confidence in their ability to carry out basic medical genetic tasks is low among participating primary care physicians: 44.2% are not confident, 36.5% somewhat confident, confident or very confident are 19.3%. In each country, those confident/very confident represent less than 33% of the participating physicians. Primary care physicians who report the lowest levels of confidence prove to be those least exposed to medical genetics information and training. Although there are significant differences in the way in which professional education is organised and practice is regulated across European countries, there is a need for a coordinated European effort to improve primary care physicians' background in medical genetics.

Who is being referred to cancer genetic counseling? Characteristics of counselees and their referral

“…In the Netherlands, genetic counseling is covered by compulsory health insurance and is therefore available to all patients, who must be referred to a family cancer clinic by a physician [general practitioner (GP) or medical specialist]. However, physicians often feel they lack sufficient knowledge to select patients eligible for cancer genetic counseling correctly (Ardern-Jones et al 2005;McCann et al 2005;Nippert et al 2011), or they may desist from bringing up subjects like family history, genetic testing and hereditary cancer and only discuss them if the patient initiates it as shown for the Netherlands (Van Riel et al 2010) and the UK (Al-Habsi et al 2008). In general, the quality of family history taking by GPs and medical specialists is poor as has been reported for 14 West European countries (Vasen et al 2010) so that patients who fulfil the criteria for cancer genetic counseling are not always identified and referred.…”

Neither as harmful as feared by critics nor as empowering as promised by providers: risk information offered direct to consumer by personal genomics companies

“…On the other hand, it is not self-evident that consumers would be better off if genomic testing were only available through a physician. Studies show that most physicians lack training and knowledge in genomics (Baars et al 2005;Nippert et al 2011;cf. Beaudet 2010).…”

“…To require pre-test consultation with a healthcare provider seems overly paternalistic and also flawed given most physicians' limited understanding of genetics and statistics, as indicated by studies referred to above (Baars et al 2005;Nippert et al 2011;cf. Beaudet 2010;cf Bloss et al 2011b;Wegwart and Gigerenzer 2011).…”

Are family-oriented interventions in Portuguese genetics services a remote possibility? Professionals’ views on a multifamily intervention for cancer susceptibility families

“…The role of primary care physicians should also be considered. Lack of training and confidence of these professionals to carry out medical genetics tasks has been stated (Nippert et al 2011). Given the amount of patients referred for oncogenetic services by primary care physicians, training in specific issues about genetics, namely in how to make appropriate referrals for cancer risk counselling, may indeed improve the service.…”