ABSTRACT
Cancer genetic counseling and testing are now integral services in progressive cancer care. There has been much debate over whether these services should be delivered by providers with specialized training in genetics or by all clinicians. Adverse outcomes resulting from cancer genetic counseling and testing performed by clinicians without specialization in genetics have been reported, but formal documentation is sparse. In this review, we present a series of national cases illustrating major patterns of errors in cancer genetic counseling and testing and the resulting impact on medical liability, health care costs, and the patients and their families.
Subject(s)
Genetic Counseling , Genetic Testing , Health Knowledge, Attitudes, Practice , Neoplasms/genetics , Diagnostic Errors , Female , Genetic Counseling/economics , Genetic Counseling/ethics , Genetic Counseling/legislation & jurisprudence , Genetic Counseling/standards , Genetic Predisposition to Disease , Genetic Testing/economics , Genetic Testing/ethics , Genetic Testing/legislation & jurisprudence , Genetic Testing/standards , Humans , Liability, Legal , Medical Errors , Risk Assessment , Unnecessary ProceduresABSTRACT
The purpose of this study was to assess primary care physicians' awareness, experience, opinions and preparedness to answer patients' questions regarding direct-to-consumer (DTC) genetic testing. An anonymous survey was mailed to 2,402 family and internal medicine providers in North Carolina. Of the 382 respondents, 38.7% (n = 148) were aware of and 15% (n = 59) felt prepared to answer questions about DTC genetic tests. Respondents aged 50 or older were more likely to be aware of DTC genetic testing than those less than 40 years old (OR = 2.42). Male providers were more likely to feel prepared to answer questions than female providers (OR = 2.65). Among respondents who reportedly were aware, family practitioners were more likely than internists (OR = 3.30) to think DTC testing was clinically useful, and 18.9% had patients ask questions or bring in test results. The small percent of physicians who were aware of DTC genetic testing or felt prepared to answer questions about it suggests that education of providers will be necessary if testing becomes more widespread.
Subject(s)
Attitude of Health Personnel , Genetic Counseling/statistics & numerical data , Genetic Testing/statistics & numerical data , Patient Education as Topic/statistics & numerical data , Physician-Patient Relations , Physicians, Primary Care/statistics & numerical data , Primary Health Care/statistics & numerical data , Adult , Aged , Female , Genetic Counseling/methods , Genetic Predisposition to Disease , Genetic Testing/methods , Humans , Internal Medicine , Male , Middle Aged , North Carolina/epidemiology , Sex Factors , Surveys and QuestionnairesABSTRACT
To assess the educational needs of North Carolina primary care physicians (PCPs) about direct-to-consumer (DTC) genetic testing, surveys were mailed to 2,402 family and internal medicine providers in North Carolina. Out of 382 respondents, 323 (85%) felt unprepared to answer patient questions and 282 (74%) reported wanting to learn about DTC genetic testing. A total of 148 (39%) were aware of DTC genetic testing. Among these, 63 (43%) thought DTC genetic testing was clinically useful. PCPs who felt either unprepared to answer patient questions (OR = 0.354, p = 0.01) or that DTC genetic testing was clinically useful (OR = 5.783, p = 0.00) were more likely to want to learn about DTC genetic testing. PCPs are interested in learning about DTC genetic testing, but are mostly unaware of DTC testing and feel unprepared to help patients with DTC testing results. Familiar and trusted channels that provide the information and tools PCPs need to help answer patient's questions and manage their care should be used when creating educational programs.
