How Should Primary Care Physicians Respond to Direct-to-Consumer Genetic Test Results?

Abstract

In this case, a primary care physician is presented with direct-toconsumer genetic test results and asked to provide counseling and order follow-up diagnostics. In order to deal effectively with this situation, we suggest physicians need look no further than the practice principles that guide more routine clinical encounters. We examine the rationale behind 2 major clinical ethical considerations: (1) physicians have obligations to help their patients achieve reasonable health goals but are not obligated to perform procedures that are not medically indicated; and (2) primary care physicians do not need to know everything; they just need to know how to get their patients appropriate care. CaseA 34-year-old woman, Sarah, schedules a routine visit with her family physician, Dr S, to discuss results of a direct-to-consumer genetic test she ordered from an online vendor. After sending a saliva sample, Sarah received several reports that she accessed online and printed for her visit with Dr S. quantitative, and normative research on ethical and regulatory issues raised by both biorepository research and pediatric translational and clinical genomics.Esther E. Knapp, MD, MBE is a pediatric hematologist-oncologist at the University of Louisville School of Medicine in Louisville, Kentucky. She completed additional fellowship training in pediatric stem cell transplant medicine. Her research interests as a bioethicist and clinician focus on ethical issues in transplant medicine, pediatric precision oncology, and clinician moral distress.

Physician awareness, preparedness, and opinions toward consumer‐initiated genetic testing in Thailand: Views from a changing landscape

“…These findings can be expected as our study was performed in an area where consumer-initiated genetic testing had just become reported by studies that surveyed practicing physicians (Bernhardt et al, 2012;Powell et al, 2012). These findings were consistent with et al, 2018), and when to refer patients to clinical geneticists (Artin et al, 2019;Brothers & Knapp, 2018). Also, physicians should be informed that they should respond to patients respectfully and not ignore their use of consumer-initiated genetic tests, as this could jeopardize the provider-patient relationship (Artin et al, 2019) et al, 2020).…”

Health and kinship matter: Learning about direct-to-consumer genetic testing user experiences via online discussions

“…Yet the availability of DTC health-related products has generated significant concerns by professionals. While some commentators and clinicians reportedly feel comfortable assisting their patients to interpret these results [ 14 , 15 ], others worry that healthcare providers are ill-prepared or unwilling to assist test recipients who seek advice and medical interventions [ 16 – 20 ] and that these results could increase health care utilization and divert resources from more pressing issues [ 21 – 23 ]. Indeed, several studies indicate that some consumers do seek medical advice but they are not always satisfied [ 24 , 25 ].…”

General practitioners’ (GPs) experience, attitudes and needs on clinical genetic services: a systematic review

“…Furthermore, a study has found that the use of DTC testing lack standardised laboratory practices and is prone to misclassification in risk assessment and should be used with caution for clinical care decisions. 91 This may pose as a risk for GPs who could be less attuned to the heightened levels of scrutiny towards DTC testing and accept genetic test results at face value. 90 Yet, GPs remained well positioned to assist their patients in informing their family members about genetic testing options in view of their long-standing relationship.…”