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Reported referral for genetic counseling or BRCA 1/2 testing among United States physicians
Author(s) -
Trivers Katrina F.,
Baldwin LauraMae,
Miller Jacqueline W.,
Matthews Barbara,
Andrilla C. Holly A.,
Lishner Denise M.,
Goff Barbara A.
Publication year - 2011
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.26166
Subject(s) - medicine , genetic counseling , family medicine , vignette , genetic testing , specialty , referral , medicaid , relative risk , population , confidence interval , health care , environmental health , psychology , social psychology , genetics , economics , biology , economic growth
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.