BACKGROUND Recent evidence has shown low and inconsistent rates of family history screening among generalist physicians. Little has been done to investigate the physician factors likely to mediate this behavior. We investigated family physicians' beliefs about screening their patients for inherited cancer risk, measuring their perceptions of self-effi cacy and the importance of screening.METHODS We mailed a cross-sectional, 1-page questionnaire to all active members (691) of the Massachusetts Academy of Family Physicians, measuring their attitudes about predictive genetic cancer screening.
RESULTSWe received responses from 300 of the 691 members (43%). Although 87% believed screening to be important, less than two thirds believed they were effective in screening.CONCLUSIONS Many family physicians lack confi dence in their ability to screen patients for a family history of cancer despite recognizing its importance to their practice.
INTRODUCTIONA s advances are made in the scope and effectiveness of tailoring prevention efforts to the degree of familial or genetic cancer risk, the ability to screen patients for such risk will become increasingly important. Screening in the context of this study refers to the process of collecting and recognizing patient family histories that warrant further assessment for a hereditary cancer syndrome, such as hereditary breast and ovarian cancer.Much of the research on incorporating screening for genetic cancer risk into primary care practice has been conducted in Great Britain. English and Scottish general practitioners show low rates of history taking for a family history of cancer, 1 lack confi dence in their ability to screen for multifactorial disorders, 2 and have a high frequency of inappropriate referrals to genetic specialists.3,4 Even so, educational support and guideline interventions in their health care systems can be effective in improving these behaviors.4-7 US primary care physicians have also shown defi ciencies in family history taking for cancer risk and in genetic referral patterns.8 Direct observation of US family practices also has found infrequent and brief overall family history-taking efforts. The attitudes and beliefs that physicians hold might be important determinants of their screening behavior for a family history of cancer. For example, physicians who believe it is not important to their own practice to screen for cancer risk might be less likely to do so. Even when physicians believe in the importance of screening, those who lack confi dence in their ability to screen for cancer risk (self-effi cacy) might be more hesitant to do so. Consistent with social cognitive theory, self-effi cacy has a strong infl uence on human behavior, 10,11 including physician practice behavior.
METHODSWe conducted a survey of the Massachusetts Academy of Family Physicians (MAFP) in the summer of 2002. We mailed an initial questionnaire to all members (n = 691) with 2 follow-up contacts to nonresponders at 3-week intervals. A physician identifi cation tag was ...
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