Original Research

Journal of Genetic Counseling

, Volume 21, Issue 2, pp 305-325

First online:

Barriers to and Motivations for Physician Referral of Patients to Cancer Genetics Clinics

  • Carrie F. ProchniakAffiliated withDepartment of Women’s Health/Oncology, Aurora Health Care Email author 
  • , Lisa J. MartinAffiliated withDivisions of Biostatistics and Epidemiology and Human Genetics, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati School of Medicine
  • , Erin M. MillerAffiliated withThe Heart Institute, Cincinnati Children’s Hospital Medical Center
  • , Sara C. KnapkeAffiliated withDivision of Human Genetics, Cincinnati Children’s Hospital Medical Center

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Although it is well known that under-referral of colon cancer patients to cancer genetics clinics is a chronic problem, no study has yet examined why physicians may be ordering testing independently rather than referring patients to cancer genetics clinics. The current study explored variables which may impact a physician’s preference for ordering testing independently or referring patients to outside cancer genetics experts. An online questionnaire, distributed to the membership of the American College of Gastroenterology and the American Society of Colorectal Surgeons, yielded responses from 298 physicians. Motivations to refer to cancer genetics clinics rather than order testing independently included fear of genetic discrimination and a belief that patients benefit from genetic counseling about the risks, benefits and consequences of testing. These results suggest that in order to increase referrals, genetic counselors must educate physicians about the unique benefits patients receive from participating in genetic counseling.


Genetic counseling Hereditary colorectal cancer Genetic testing Referral Risk assessment