Barriers to Translating Emerging Genetic Research on Smoking into Clinical Practice

Perspectives of Primary Care Physicians

Authors

  • Alexandra E. Shields PhD,

    1. Health Policy Institute, Georgetown Public Policy Institute, Georgetown University, Washington, DC, USA
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  • David Blumenthal MD, MPH,

    1. Institute for Health Policy, Massachusetts General Hospital/Partners HealthCare System, Boston, MA, USA
    2. Departments of Medicine and Health Care Policy, Harvard Medical School, Boston, MA, USA
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  • Kevin B. Weiss MD, MPH,

    1. Midwest Center for Health Services and Policy Research, Hines VA Medical Center, Hines, IL, USA
    2. Center for Healthcare Studies and Division of General Medicine, Department of Medicine, Northwestern Feinberg School of Medicine, Chicago, IL, USA
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  • Catherine B. Comstock MPH,

    1. Health Policy Institute, Georgetown Public Policy Institute, Georgetown University, Washington, DC, USA
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  • Douglas Currivan PhD,

    1. Survey Research Division, RTI International, Research Triangle Park, NC, USA
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  • Caryn Lerman PhD

    1. Department of Psychiatry, University of Pennsylvania Abramson Cancer Center, Philadelphia, PA, USA
    2. Annenberg Public Policy Center, Philadelphia, PA, USA.
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  • None of the authors has any conflicts of interest related to this study.

Address correspondence and requests for reprints to Dr. Shields: Health Policy Institute, Georgetown University, 2233 Wisconsin Avenue, NW, Suite 525, Washington, DC 20007 (e-mail: shieldsa@georgetown.edu).

Abstract

Objective: Smoking remains the leading cause of preventable death nationally. Emerging research may lead to improved smoking cessation treatment options, including tailoring treatment by genotype. Our objective was to assess primary care physicians' attitudes toward new genetic-based approaches to smoking treatment.

Design and Setting: A 2002 national survey of primary care physicians. Respondents were randomly assigned a survey including 1 of 2 scenarios: a scenario in which a new test to tailor smoking treatment was described as a “genetic” test or one in which the new test was described as a “serum protein” test.

Participants: The study sample was randomly drawn from all U.S. primary care physicians in the American Medical Association Masterfile (e.g., those with a primary specialty of internal medicine, family practice, or general practice). Of 2,000 sampled physicians, 1,120 responded, yielding a response rate of 62.3%.

Measurements and Main Results: Controlling for physician and practice characteristics, describing a new test as “genetic” resulted in a regression-adjusted mean adoption score of 73.5, compared to a score of 82.5 for a nongenetic test, reflecting an 11% reduction in physicians' likelihood of offering such a test to their patients.

Conclusions: Merely describing a new test to tailor smoking treatment as “genetic” poses a significant barrier to physician adoption. Considering national estimates of those who smoke on a daily basis, this 11% reduction in adoption scores would translate into 3.9 million smokers who would not be offered a new genetic-based treatment for smoking. While emerging genetic research may lead to improved smoking treatment, the potential of novel interventions will likely go unrealized unless barriers to clinical integration are addressed.

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