How do Physicians Decide to Refer Their Patients for Psychiatric Genetic Counseling? A Qualitative Study of Physicians’ Practice

Abstract

Psychiatric genetic counseling (PGC) is an emerging specialty discipline within the genetic counseling profession. A specialist PGC service was founded in 2012 in Vancouver, Canada, and though patient benefits have been demonstrated, many physicians do not regularly refer patients to the service despite awareness of its availability. We conducted a qualitative study involving semistructured telephone interviews with Vancouver-based physicians who were aware of the PGC service to explore this phenomenon. Interviews were audio-recorded, transcribed verbatim, coded, and analysed for emergent themes. Consistent with a grounded theory approach, constant comparison was employed throughout data collection and analysis. Analyses of interviews conducted with 12 physicians revealed that referral practices were informed by perceptions about the purpose of PGC and interpretation of patient cues. Physicians perceived PGC as an information-focused intervention, and considered referral when patients explicitly expressed desire for information about recurrence risk or etiology that they feel unable to adequately address themselves. Even when physicians identified psychotherapeutic benefits of PGC, patient needs of this nature were not perceived as cues prompting referral to PGC. These data suggest that further work is necessary to position PGC in physicians' minds as a service that could potentially benefit most individuals with psychiatric disorders and their families, and that encompasses more than information provision. It is important to increase physicians' awareness of the complementary role that genetic counselors can play to that of the physician in providing psychotherapeutically oriented counselling about illness etiology.

Psychiatric genetic counseling: A mapping exercise

“…Clearly, PGC is a personalized process aimed at helping people with a personal or family history of psychiatric illness understand its etiological mechanisms as a critical component and use counseling strategies to adapt to psychological and familial implications of the disease. Yet, even among healthcare providers familiar with specialist PGC services, awareness of the full scope of what the service entails seems to be limited (Leach et al, ).…”

Racial and ethnic differences in genetic counseling experiences and outcomes in the United States: A systematic review

“…Racial and ethnic disparities in access to and participation in genetics research, testing, and counseling have been identified (Armstrong, Micco, Carney, Stopfer, & Putt, 2005;Butrick et al, 2015;Levy et al, 2011;Peters, Rose, & Armstrong, 2004;Suther & Kiros, 2009). Barriers such as lack of physician knowledge or awareness of genetic counseling may contribute to fewer referrals to genetic counseling and even discrepant referrals of ethnically and racially diverse individuals (Leach et al, 2016;Prochniak, Martin, Miller, & Knapke, 2012;Rolnick et al, 2011;Trivers et al, 2011). When referred, rates of uptake of genetic counseling in some racial and ethnic minority groups are similar to each other, but in other cases rates of uptake are lower compared with similar groups of White individuals (Forman & Hall, 2009;Halbert et al, 2012).…”

The composition and capacity of the clinical genetics workforce in high-income countries: a scoping review

“…116,117,120 Overall, the main themes cited as barriers to referral were low perceived benefit for their patient, high costs, and limited availability of services. 97,118,[121][122][123] Two studies assessed the use of interventions to increase referral rates. 124,125 One study demonstrated that the introduction of a Genetics Referral Toolkit designed specifically to target barriers to referral (which included a referral template, genetic risk checklist, and a family history worksheet) improved referral rates in a cancer setting.…”