Genomic Risk Profiling: Attitudes and Use in Personal and Clinical Care of Primary Care Physicians Who Offer Risk Profiling
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Genomic risk profiling involves the analysis of genetic variations linked through statistical associations to a range of disease states. There is considerable controversy as to how, and even whether, to incorporate these tests into routine medical care.
To assess physician attitudes and uptake of genomic risk profiling among an ‘early adopter’ practice group.
We surveyed members of MDVIP, a national group of primary care physicians (PCPs), currently offering genomic risk profiling as part of their practice.
All physicians in the MDVIP network (N = 356)
We obtained a 44% response rate. One third of respondents had ordered a test for themselves and 42% for a patient. The odds of having ordered personal testing were 10.51-fold higher for those who felt well-informed about genomic risk testing (p < 0.0001). Of those who had not ordered a test for themselves, 60% expressed concerns for patients regarding discrimination by life and long-term/disability insurers, 61% about test cost, and 62% about clinical utility. The odds of ordering testing for their patients was 8.29-fold higher among respondents who had ordered testing for themselves (p < 0.0001). Of those who had ordered testing for patients, concerns about insurance coverage (p = 0.014) and uncertain clinical utility (p = 0.034) were associated with a lower relative frequency of intention to order testing again in the future.
Our findings demonstrate that respondent familiarity was a key predictor of physician ordering behavior and clinical utility was a primary concern for genomic risk profiling. Educational and interpretive support may enhance uptake of genomic risk profiling.
KEY WORDSprimary care genetic testing risk education
The authors thank Dr. Hunt Willard for his helpful comments on the manuscript and Ms. Genevieve Tindall for her assistance on the project and manuscript. This work was supported in part by The Duke Endowment (Health Care Division) (S.B.H, J.M.O, L.K-J., G.G., A.C.) and National Institute on Drug Abuse (NIDA) Grant P30 DA023026 (M.M.C.). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of NIDA.
Conflict of Interest
Duke University has no relationship with MDVIP. The Executive Health program at Duke University Medical Center offers genomic risk assessments to interested patients, including but not limited to tests provided by Navigenics.
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