Medical Genetic Counseling for Breast Cancer in Primary Care: A Synthesis of Major Determinants of Physicians' Practices in Primary Care Settings

Jbilou, Jalila; Halilem, Norrin; Blouin-Bougie, Jolyane; Amara, Nabil; Landry, Réjean; Simard, Jacques

doi:10.1159/000362358

Cited by 13 publications

(14 citation statements)

References 72 publications

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“…beliefs in personal clinical intuition against trust in the tool’s usefulness [ 15 ]), and (3) educative barriers (e.g. skills needed to understand numerical risk estimates and to communicate them to patients [ 16 ]).…”

Section: Introductionmentioning

confidence: 99%

Use of the BOADICEA Web Application in clinical practice: appraisals by clinicians from various countries

et al. 2017

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The ‘BOADICEA’ Web Application (BWA) used to assess breast cancer risk, is currently being further developed, to integrate additional genetic and non-genetic factors. We surveyed clinicians’ perceived acceptability of the existing BWA v3. An online survey was conducted through the BOADICEA website, and the British, Dutch, French and Swedish genetics societies. Cross-sectional data from 443 participants who provided at least 50% responses were analysed. Respondents varied in age and, clinical seniority, but mainly comprised women (77%) and genetics professionals (82%). Some expressed negative opinions about the scientific validity of BOADICEA (9%) and BWA v3 risk presentations (7–9%). Data entry time (62%), clinical utility (22%) and ease of communicating BWA v3 risks (13–17%) received additional negative appraisals. In multivariate analyses, controlling for gender and country, data entry time was perceived as longer by genetic counsellors than clinical geneticists (p < 0.05). Respondents who (1) considered hormonal BC risk factors as more important (p < 0.01), and (2) communicated numerical risk estimates more frequently (p < 0.001), judged BWA v3 of lower clinical utility. Respondents who carried out less frequent clinical activity (p < 0.01) and respondents with ‘11 to 15 years’ seniority (p < 0.01) had less favourable opinions of BWA v3 risk presentations. Seniority of ‘6 to 10 years’ (p < 0.05) and more frequent numerical risk communication (p < 0.05) were associated with higher fear of communicating the BWA v3 risks to patients. The level of genetics training did not affect opinions. Further development of BWA should consider technological, genetics service delivery and training initiatives.Electronic supplementary materialThe online version of this article (doi:10.1007/s10689-017-0014-x) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Use of the BOADICEA Web Application in clinical practice: appraisals by clinicians from various countries

et al. 2017

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“…However, some types of results may eventually be returned by a primary care provider or interactive, web-based format. Many physicians today lack specialized genetics training and are thus unprepared to deliver genome sequencing results (Guttmacher et al 2007(Guttmacher et al , 2010Plon et al 2011;Townsend et al 2012), potentially leading to misinterpretation of findings (Domanska et al 2009;Jbilou et al 2014;McLaughlin et al 2014). However, with training and support from genetics specialists, primary care physicians may be able to serve in this role Vassy et al 2014).…”

Section: Discussionmentioning

confidence: 99%

How, who, and when: preferences for delivery of genome sequencing results among women diagnosed with breast cancer at a young age

Kaphingst

Ivanovich

Elrick

et al. 2016

Mol Genet Genomic Med

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BackgroundThe increasing use of genome sequencing with patients raises a critical communication challenge: return of secondary findings. While the issue of what sequencing results should be returned to patients has been examined, much less attention has been paid to developing strategies to return these results in ways that meet patients' needs and preferences. To address this, we investigated delivery preferences (i.e., who, how, when) for individual genome sequencing results among women diagnosed with breast cancer at age 40 or younger.MethodsWe conducted 60 semistructured, in‐person individual interviews to examine preferences for the return of different types of genome sequencing results and the reasons underlying these preferences. Two coders independently coded interview transcripts; analysis was conducted using NVivo 10.ResultsThe major findings from the study were that: (1) many participants wanted sequencing results as soon as possible, even at the time of breast cancer diagnosis; (2) participants wanted an opportunity for an in‐person discussion of results; and (3) they put less emphasis on the type of person delivering results than on the knowledge and communicative skills of that person. Participants also emphasized the importance of a results return process tailored to a patient's individual circumstances and one that she has a voice in determining.ConclusionsA critical goal for future transdisciplinary research including clinicians, patients, and communication researchers may be to develop decision‐making processes to help patients make decisions about how they would like various sequencing results returned.

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“…Knowledge about genetic cancer risk and referrals have dramatically changed over the 20-year period 13 covered by those studies that were reviewed. It is also recognised that the studied population is a sub-population in primary care.…”

Section: Box 2 Clinicians' Attitudes To Testing For Genetic Cancer Riskmentioning

confidence: 99%

“…9 However, GPs may face challenges regarding this expanding role due to a lack of clinical genetics knowledge, perceived lack of confidence in the domain, and time constraints. 3,[10][11][12][13][14][15] There may be difficulties in considering genetic cancer risk in routine primary care visits, especially as…”

Section: Introductionmentioning

confidence: 99%

Genetic cancer risk assessment in general practice: systematic review of tools available, clinician attitudes, and patient outcomes

et al. 2018

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BackgroundA growing demand for cancer genetic services has led to suggestions for the involvement of GPs. How, and in which conditions, they can be involved, and whether there are important barriers to implementation should be ascertained.AimTo review the tools available, clinician attitudes and experiences, and the effects on patients of genetic cancer risk assessment in general practice.Design and settingSystematic review of papers published worldwide between 1996 and 2017.MethodThe MEDLINE (via Ovid), EMBASE, Cochrane Library, CINAHL, and PsycINFO databases and grey literature were searched for entries dating from January 1996 to December 2017. Study quality was assessed with relevant Critical Appraisal Skills Programme tool checklists and a narrative synthesis of findings was conducted.ResultsIn total, 40 studies were included in the review. A variety of testing and screening tools were available for genetic cancer risk assessment in general practice, principally for breast, breast–ovarian, and colorectal cancer risk. GPs often reported low knowledge and confidence to engage with genetic cancer risk assessment; however, despite time pressures and concerns about confidentiality and the impact of results on family members, some recognised the potential importance relating to such a development of the GP’s role. Studies found few reported benefits for patients. Concerns about negative impacts on patient anxiety and cancer worries were largely not borne out.ConclusionGPs may have a potential role in identifying patients at risk of hereditary cancer that can be facilitated by family-history tools. There is currently insufficient evidence to support the implementation of population-wide screening for genetic cancer risk, especially given the competing demands of general practice.

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Medical Genetic Counseling for Breast Cancer in Primary Care: A Synthesis of Major Determinants of Physicians' Practices in Primary Care Settings

Cited by 13 publications

References 72 publications

Use of the BOADICEA Web Application in clinical practice: appraisals by clinicians from various countries

Use of the BOADICEA Web Application in clinical practice: appraisals by clinicians from various countries

How, who, and when: preferences for delivery of genome sequencing results among women diagnosed with breast cancer at a young age

Genetic cancer risk assessment in general practice: systematic review of tools available, clinician attitudes, and patient outcomes

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