Reported referral for genetic counseling or BRCA 1/2 testing among United States physicians

A vignette-based study

Authors

  • Katrina F. Trivers PhD, MSPH,

    Corresponding author
    1. Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
    • Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, MS K-55, Atlanta, GA 30341
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    • Fax: (770) 488-4639

  • Laura-Mae Baldwin MD, MPH,

    1. Department of Family Medicine, University of Washington School of Medicine, Seattle, Washington
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  • Jacqueline W. Miller MD,

    1. Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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  • Barbara Matthews MBA,

    1. Department of Family Medicine, University of Washington School of Medicine, Seattle, Washington
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  • C. Holly A. Andrilla MS,

    1. Department of Family Medicine, University of Washington School of Medicine, Seattle, Washington
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  • Denise M. Lishner MSW,

    1. Department of Family Medicine, University of Washington School of Medicine, Seattle, Washington
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  • Barbara A. Goff MD

    1. Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington
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  • We thank Blythe Ryerson from the Centers for Disease Control and Prevention for her early contributions to the development of the study's methods and Gilmore Research Group in Seattle, Washington, for conducting the survey.

  • The findings and conclusions of this study are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Abstract

BACKGROUND:

Genetic counseling and testing is recommended for women at high but not average risk of ovarian cancer. National estimates of physician adherence to genetic counseling and testing recommendations are lacking.

METHODS:

Using a vignette-based study, we surveyed 3200 United States family physicians, general internists, and obstetrician/gynecologists and received 1878 (62%) responses. The questionnaire included an annual examination vignette asking about genetic counseling and testing. The vignette varied patient age, race, insurance status, and ovarian cancer risk. Estimates of physician adherence to genetic counseling and testing recommendations were weighted to the United States primary care physician population. Multivariable logistic regression identified independent patient and physician predictors of adherence.

RESULTS:

For average-risk women, 71% of physicians self-reported adhering to recommendations against genetic counseling or testing. In multivariable modeling, predictors of adherence against referral/testing included black versus white race (relative risk [RR], 1.16; 95% confidence interval [CI], 1.03-1.31), Medicaid versus private insurance (RR, 1.15; 95% CI, 1.02-1.29), and rural versus urban location. Among high-risk women, 41% of physicians self-reported adhering to recommendations to refer for genetic counseling or testing. Predictors of adherence for referral/testing were younger patient age [35 vs 51 years [RR, 1.78; 95% CI, 1.41-2.24]), physician sex (female vs male [RR, 1.30; 95% CI, 1.07-1.64]), and obstetrician/gynecologist versus family medicine specialty (RR, 1.64; 95% CI, 1.31-2.05). For both average-risk and high-risk women, physician-estimated ovarian cancer risk was the most powerful predictor of recommendation adherence.

CONCLUSION:

Physicians reported that they would refer many average-risk women and would not refer many high-risk women for genetic counseling/testing. Intervention efforts, including promotion of accurate risk assessment, are needed. Cancer 2011;. © 2011 American Cancer Society.

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