Attitudes and Practices Among Internists Concerning Genetic Testing
- 1.4k Downloads
Many questions remain concerning whether, when, and how physicians order genetic tests, and what factors are involved in their decisions. We surveyed 220 internists from two academic medical centers about their utilization of genetic testing. Rates of genetic utilizations varied widely by disease. Respondents were most likely to have ordered tests for Factor V Leiden (16.8 %), followed by Breast/Ovarian Cancer (15.0 %). In the past 6 months, 65 % had counseled patients on genetic issues, 44 % had ordered genetic tests, 38.5 % had referred patients to a genetic counselor or geneticist, and 27.5 % had received ads from commercial labs for genetic testing. Only 4.5 % had tried to hide or disguise genetic information, and <2 % have had patients report genetic discrimination. Only 53.4 % knew of a geneticist/genetic counselor to whom to refer patients. Most rated their knowledge as very/somewhat poor concerning genetics (73.7 %) and guidelines for genetic testing (87.1 %). Most felt needs for more training on when to order tests (79 %), and how to counsel patients (82 %), interpret results (77.3 %), and maintain privacy (80.6 %). Physicians were more likely to have ordered a genetic test if patients inquired about genetic testing (p < .001), and if physicians had a geneticist/genetic counselor to whom to refer patients (p < .002), had referred patients to a geneticist/genetic counselor in the past 6 months, had more comfort counseling patients about testing (p < .019), counseled patients about genetics, larger practices (p < .032), fewer African-American patients (p < .027), and patients who had reported genetic discrimination (p < .044). In a multiple logistic regression, ordering a genetic test was associated with patients inquiring about testing, having referred patients to a geneticist/genetic counselor and knowing how to order tests. These data suggest that physicians recognize their knowledge deficits, and are interested in training. These findings have important implications for future medical practice, research, and education.
KeywordsGenetic testing Medical education Doctor-patient communication Ethics Genetic discrimination Decision-making Genetic counseling
The authors would like to thank Meghan Sweeney, Patricia Contino and Melissa Salm. This research was funded by the National Human Genome Research Institute, Ethical, Legal and Social Implications Program; R-01-HG002431-01; “Views of Privacy of Genetic Information,” and the National Human Genome Research Institute, “Center for ELSI Research on Psychiatric Neurologic and Behavioral Genetics,” 1P20HG005535-01.
- EGAPP Working Group. (2011). EGAPP Working Group Recommendations. https://doi.org/www.egappreviews.org/recommendations/index.htm. Accessed 12 January 2012.
- Goldman, J. S., Hahn, S. E., Catania, J. W., LaRusse-Eckert, S., Butson, M. B., Rumbaugh, M., et al. (2011). Genetic counseling and testing for Alzheimer disease: Joint practice guidelines of the American College of Medical Genetics and the National Society of Genetic Counselors. Genetics in Medicine, 13(6), 597–605.CrossRefGoogle Scholar
- Gollob, M. H., Blier, L., Brugada, R., Champagne, J., Chauhan, V., Connors, S., et al. (2011). Recommendations for the use of genetic testing in the clinical evaluation of inherited cardiac arrhythmias associated with sudden cardiac death: Canadian Cardiovascular Society/Canadian Heart Rhythm Society joint position paper. Canadian Journal of Cardiology, 27(2), 232–245.CrossRefGoogle Scholar
- Haga, S. B., Carrig, M. M., O’Daniel, J. M., Orlando, L. A., Killeya-Jones, L. A., Ginsburg, G. S., & Cho, A. (2011). Genomic risk profiling: attitudes and use in personal and clinical care of primary care physicians who offer risk profiling. Journal of General Internal Medicine, 26(8), 834–840.CrossRefGoogle Scholar
- Myers, M. F., & Jorgensen, C. (2005). Direct-to-consumer marketing campaign: Genetic testing for susceptibility to breast and ovarian cancer. From: Centers for Disease Control and Prevention, Office of Genomics and Disease Prevention. (2005). Genomics and Population Health 2005. Atlanta, GA.Google Scholar
- Runy, L. A. (2009). Physician Snapshot: A current and future look at physician demographics in America. Hospital and Health Networks. https://doi.org/www.hhnmag.com/hhnmag_app/jsp/articledisplay.jsp?dcrpath=HHNMAG/Article/data/08AUG2009/0908HHN_FEA_Gatefold&domain=HHNMAG. Accessed 1 February 2012.
- Stanek, E. J., Sanders, C. L., Teagarden, J. R., Agatep, B. C., Johansen, K. A. et al. (2009). National Pharmacogenomics physician survey: Who are the physicians adopting pharmacogenomics and how does knowledge impact adoption? Presented at the 59th Annual American Society of Human Genetics (ASHG) Meeting. https://doi.org/www.medcoresearchinstitute.com/docs/ASHG_Clinical-Brief.pdf. Accessed 13 September 2011.
- Taylor, S., Treloar, S., Barlow-Stewart, K., Otlowski, M., & Stranger, M. (2007). Investigating genetic discrimination in Australia: perceptions and experiences of clinical genetics service clients regarding coercion to test, insurance and employment. Australian Journal of Emerging Technologies and Society, 5(2), 63–83.Google Scholar
- Tu, H. T. & O’Malley, A. S. (2007). Exodus of male physicians from primary care drives shift to specialty practice. Tracking Report No. 17. https://doi.org/hschange.org/CONTENT/934/#ib2 Accessed 31 Jan 2012.
- Wideroff, L., Freedman, A. N., Olson, L., Klabunde, C. N., Davis, W., Srinath, K. P., et al. (2003). Physician use of genetic testing for cancer susceptibility: results of a national survey. Cancer Epidemiology, Biomarkers & Prevention, 12(4), 295–303.Google Scholar