US physicians' attitudes toward genetic testing for cancer susceptibility

Abstract

Genetic testing for an inherited susceptibility to cancer is an emerging technology in medical practice. Little information is currently available about physicians' attitudes toward these tests. To assess US physicians' opinions on unresolved issues surrounding genetic testing, a 15-min survey was administered to a stratified random sample of 1,251 physicians from 8 specialties, selected from a file of all licensed physicians in the US (response rate = 71.0%). Dependent measures included physicians' attitudes toward genetic counseling and testing qualifications, availability of guidelines, patient confidentiality and insurance discrimination issues, and clinical utility of genetic tests. More than 89% of physicians reported a need for physician guidelines, 81% thought that patients with positive genetic test results are at risk for insurance discrimination, and more than 53% thought that it was difficult to ensure the confidentiality of test results. Almost 25% indicated that genetic tests for cancer susceptibility have too many inaccurate or ambiguous results; nearly 75% thought that clear guidelines are not available for managing patients with positive test results. Only 29% of physicians reported feeling qualified to provide genetic counseling to their patients. More than 84% of oncologists considered themselves qualified to recommend genetic testing to their patients compared with 40% of primary care physicians (PCPs), and 57% of tertiary care physicians (TCPs). US physicians expressed great uncertainty about issues surrounding genetic testing for cancer susceptibility. Results of this national survey underscore the need to provide physicians with clear guidelines on the use of genetic cancer susceptibility tests and effective medical training on their appropriate implementation.

Autism genetic testing: a qualitative study of awareness, attitudes, and experiences among parents of children with autism spectrum disorders

“…Furthermore, although the lay public has deficient awareness of genetic testing, this is also the case with health-care providers. 30,31 As such, genomic education for health-care providers, along with the lay public, is also needed to improve the overall awareness and understanding of ASD genetic testing among both parties.…”

“…[33][34][35] In addition, studies have also found that health-care providers have limited genomic competencies for discussing genetic testing with patients. 30,31 Accordingly, genomics education for health-care providers is needed to facilitate better genetic services.…”

Genomic Risk Profiling: Attitudes and Use in Personal and Clinical Care of Primary Care Physicians Who Offer Risk Profiling

“…Low perceived clinical utility, as well as concerns about potential discrimination, have repeatedly been reported as primary barriers to uptake of both traditional genetic testing and newer applications [35][36][37][38][39] . Similarly, we found that uncertain clinical utility was among the top concerns of respondents for themselves and their patients.…”

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

“…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.…”

“…35,36 The second most common ELSI barrier (n = 15 citations in 15/38 studies) was the fear of social or insurance discrimination for their patients as a result of their genetic information. 37 Freedman et al 17 found that more than 80% of 1,251 US PCPs surveyed thought that patients with positive genetic testing results were at risk for insurance discrimination. Another survey identified 70% of PCPs with this concern.…”