Genetic Services for Hereditary Breast/Ovarian and Colorectal Cancers – Physicians’ Awareness, Use and Satisfaction

Abstract

Objectives: In 2000, the Ministry of Health in Ontario, Canada, introduced a publicly funded program to provide genetic services for hereditary breast/ovarian and colorectal cancers. We surveyed physicians to determine their awareness, use and satisfaction with this program. Methods: A self-administered questionnaire was mailed to a random sample of 25% of Ontario family physicians and all gynecologists, oncologists (radiation, surgical and medical), gastroenterologists and general surgeons. Results: Response rate was 49% (n = 1,427). Awareness of genetic testing for breast/ovarian cancer was high (91%) but less for colorectal cancer (60%). Use of services was associated with physician age of 40 or greater, urban location, confidence in knowledge of referral criteria and core competencies in genetics, and awareness of the program and where to refer. Almost half were dissatisfied with notification about the program. Conclusions: Ontario physicians are aware of cancer genetics services, and use is associated with increased knowledge of services, and confidence in skills. They would like more timely services and education about hereditary cancers and susceptibility testing.

Primary-care providers’ perceived barriers to integration of genetics services: a systematic review of the literature

“…The most commonly cited barrier category within this theme was a general lack of genetic knowledge (n = 24 cited in 20/38 studies); this included specific barriers around PCPs' self-reported lack of confidence in their own knowledge about genetics in general (n = 7) 6-12 and about clinical genetics, 13 an interest in gaining insight regarding the genetic background of a disease, 14 and a lack of confidence in their ability to perform core competencies such as taking an FH, 15 including a lack of knowledge about what FH information to collect. 16 Among the several skill-related barriers identified, the most commonly cited (n = 16 citations in 16/38 studies) was a lack of confidence their ability to counsel patients about genetic risk and to manage them.…”

“…SyStematic Review for cancer susceptibility, 15,17 as well as citing a lack of overall confidence in assessing patient risk. 7,23 In their assessment of 860 US PCPs, Vig et al 24 found that 38.3% were uncomfortable with making screening and prevention recommendations and were uncertain about which patients are medically appropriate to refer.…”

“…The largest category of systems barriers was lack of access to genetics services (n = 23 citations in 17/38 studies). This encompassed specific barriers related to lack of access to genetics services in general 9,15,19,33 and a specific lack of access to genetic counselors or geneticists. 2,15,22,24,25,37,40,41 PCPs reported an inability to obtain a consultation with clinicians in four studies, noting that the location of the nearest genetics center was too inconvenient for patients to be able to access.…”

“…This encompassed specific barriers related to lack of access to genetics services in general 9,15,19,33 and a specific lack of access to genetic counselors or geneticists. 2,15,22,24,25,37,40,41 PCPs reported an inability to obtain a consultation with clinicians in four studies, noting that the location of the nearest genetics center was too inconvenient for patients to be able to access. 22,24,29,40 Chen et al 29 found that 24% of Alabama pediatricians surveyed were unable to obtain genetics consultations for their patients, 67% said it was difficult or not possible to obtain a face-to-face genetics evaluation, and 58% reported it was difficult or impossible to obtain a remote genetics evaluation.…”

“…11,21,29 In the case of genetic medicine in prenatal care, the time to obtain results was reported as being too long to inform any treatment decisions. 11,15 PCPs also reported being unclear about their role in providing genetics services (n = 15 cited in 15/38 studies). In some instances, PCPs felt that it was not their role to deliver genetics services 8,36,39 or they simply were unclear about their role.…”