Evolution of Hereditary Breast Cancer Genetic Services: Are Changes Reflected in the Knowledge and Clinical Practices of Florida Providers?

Abstract

Results highlight the need to identify whether variability in hereditary cancer service delivery impacts patient outcomes. Findings also reveal opportunities to facilitate ongoing outreach and education.

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

“…34,35,38,39,41,42,44,[47][48][49][50]55,58 In seven studies, objective knowledge was assessed with a survey utilizing a scale or test to measure accurate understanding of basic genetic principles, clinical practice guidelines, and/or features of hereditary cancer syndromes. 35,38,39,42,47,48,50 In the other six studies, case scenarios or standardized patients were used to measure PCPs' abilities to identify high-risk patients and appropriate genetic testing situations. 32,34,41,44,49,55 Aside from articles reporting on the same sample, 38,48 there was no overlap in measures.…”

“…42 In addition, three studies examined objective knowledge pertaining to legal genetic discrimination protections. 39,44,53 Knowledge in this domain was concluded to be suboptimal; for instance, in a cross-sectional survey of 1120 family practitioners and internists, 9% had accurate knowledge about legal insurance protections related to genetic test results. 53 Ten studies examined PCPs' self-reported subjective or perceived knowledge.…”

“…31,33,34,39,41,45,52,54,57 Of these, four studies provided descriptive information about PCPs' experiences discussing genetic risk and testing (2 relying on surveys in the breast cancer context 41,45 and 1 using mixed-methods in the prostate cancer context 33 ). The other used a novel study design featuring standardized patients to evaluate communication behaviors among 86 providers and found that in only 21% and 3% of encounters did providers express opinions suggesting that patients at high maternal or paternal breast cancer risk, respectively, were candidates for genetic testing.…”

“…The other used a novel study design featuring standardized patients to evaluate communication behaviors among 86 providers and found that in only 21% and 3% of encounters did providers express opinions suggesting that patients at high maternal or paternal breast cancer risk, respectively, were candidates for genetic testing. 34 Two additional studies used cross-sectional surveys to assess the extent to which PCPs adhered to clinical guidelines in discussions about consenting to hereditary breast and ovarian cancer testing 39,54 and observed that many were non-adherent (e.g., among 81 providers, 39% did not always discuss implications for family, and 64% did not always discuss the possibility of another hereditary cancer syndrome 54 ). Furthermore, two studies reported limited instances of discussions between PCPs and patients regarding direct-to-consumer testing (e.g., with 71% 45 to 92% 33 of providers not having had a patient ask questions about direct-to-consumer testing).…”

“…81 This review did not focus on how provider characteristics (e.g., training, age) may contribute to differences in the outcomes of interest; future research could explore such differences. Finally, this review does not offer insight into PCPs' experiences with novel applications of genomic testing currently being introduced into cancer care (e.g., multi-gene panel testing, although a reviewed article noted that 42% of providers have ordered such testing 39 ).…”