Cancer Genetic Risk Assessment and Referral Patterns in Primary Care

Vig, Hetal; Armstrong, Joanne; Egleston, Brian L.; Mazar, Carla; Toscano, Michele; Bradbury, Angela R.; Daly, Mary B.; Meropol, Neal J.

doi:10.1089/gtmb.2009.0037

Cited by 58 publications

(71 citation statements)

References 31 publications

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“…7,23 In their assessment of 860 US PCPs, Vig et al 24 found that 38.3% were uncomfortable with making screening and prevention recommendations and were uncertain about which patients are medically appropriate to refer. PCPs reported that it was hard to keep up to date with evidence, specifically updated and revised professional guidelines (n = 9, citations of barrier in 9/38 studies).…”

Section: Genetics In Medicine | Volume 17 | Number 3 | March 2015mentioning

confidence: 99%

“…These encompassed a lack of understanding and confidence in how and when to make a referral to a genetic professional. 14,24 Ethical, legal, and social implications…”

Section: Genetics In Medicine | Volume 17 | Number 3 | March 2015mentioning

confidence: 99%

“…This encompassed specific barriers related to lack of access to genetics services in general 9,15,19,33 and a specific lack of access to genetic counselors or geneticists. 2,15,22,24,25,37,40,41 PCPs reported an inability to obtain a consultation with clinicians in four studies, noting that the location of the nearest genetics center was too inconvenient for patients to be able to access. 22,24,29,40 Chen et al 29 found that 24% of Alabama pediatricians surveyed were unable to obtain genetics consultations for their patients, 67% said it was difficult or not possible to obtain a face-to-face genetics evaluation, and 58% reported it was difficult or impossible to obtain a remote genetics evaluation.…”

Section: Systemsmentioning

confidence: 99%

“…2,15,22,24,25,37,40,41 PCPs reported an inability to obtain a consultation with clinicians in four studies, noting that the location of the nearest genetics center was too inconvenient for patients to be able to access. 22,24,29,40 Chen et al 29 found that 24% of Alabama pediatricians surveyed were unable to obtain genetics consultations for their patients, 67% said it was difficult or not possible to obtain a face-to-face genetics evaluation, and 58% reported it was difficult or impossible to obtain a remote genetics evaluation. Iredale et al 22 found that rural location played a major role in access issues because of isolation, lack of social networks, poor transport, decreased accessibility, and lack of referral patterns to secondary and tertiary facilities.…”

Section: Systemsmentioning

confidence: 99%

“…14,31 PCPs reported that their patients' accuracy when providing FH information was a barrier, 16,21,27,28 as were language and culture barriers when discussing FH and genetics with patients. 14,21,22,27 Evidence A total of nine barriers related to current scientific evidence behind use of genetics services were identified in the studies (Supplementary Figure S4 online); the most commonly cited barrier was a perceived lack of therapeutic interventions available after the identification of increased risk (n = 11 cited in 11/38 studies) 24,27,28,36,39 and the notion that patient management would not change as a result of genetic assessment. 4,7,11,23,25,27 The second most frequently cited evidence barrier reported was the lack of guidelines and insufficient evidence to support risk assessment (n = 10 cited in 10/38 studies).…”

Section: Systemsmentioning

confidence: 99%

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Primary-care providers’ perceived barriers to integration of genetics services: a systematic review of the literature

Mikat-Stevens

Larson

Tarini

2015

Genetics in Medicine

204

216

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Purpose: We aimed to systematically review the literature to identify primary-care providers' perceived barriers against provision of genetics services. Methods:We systematically searched PubMed and ERIC using key and Boolean term combinations for articles published from 2001 to 2012 that met inclusion/exclusion criteria. Specific barriers were identified and aggregated into categories based on topic similarity. These categories were then grouped into themes.Results: Of the 4,174 citations identified by the search, 38 publications met inclusion criteria. There were 311 unique barriers that were classified into 38 categories across 4 themes: knowledge and skills; ethical, legal, and social implications; health-care systems; and scientific evidence. Barriers most frequently mentioned by primary-care providers included a lack of knowledge about genetics and genetic risk assessment, concern for patient anxiety, a lack of access to genetics, and a lack of time. Conclusion:Although studies reported that primary-care providers perceive genetics as being important, barriers to the integration of genetics medicine into routine patient care were identified. The promotion of practical guidelines, point-of-care risk assessment tools, tailored educational tools, and other systems-level strategies will assist primary-care providers in providing genetics services for their patients.

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Section: Genetics In Medicine | Volume 17 | Number 3 | March 2015mentioning

confidence: 99%

“…These encompassed a lack of understanding and confidence in how and when to make a referral to a genetic professional. 14,24 Ethical, legal, and social implications…”

Section: Genetics In Medicine | Volume 17 | Number 3 | March 2015mentioning

confidence: 99%

Section: Systemsmentioning

confidence: 99%

Section: Systemsmentioning

confidence: 99%

Section: Systemsmentioning

confidence: 99%

See 3 more Smart Citations

Primary-care providers’ perceived barriers to integration of genetics services: a systematic review of the literature

Mikat-Stevens

Larson

Tarini

2015

Genetics in Medicine

204

216

View full text Add to dashboard Cite

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A feasibility study of breast cancer genetic risk assessment in a federally qualified health center

Hoskins

Tejeda

Vijayasiri

et al. 2018

Cancer

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Background The United States Preventive Services Task Force (USPSTF) endorses routine screening for genetic risk for breast/ovarian cancer as a component of primary healthcare. Implementation of this recommendation may prove challenging, especially in clinics serving disadvantaged communities. Methods We tested the feasibility of implementing the USPSTF mandate at a Federally Qualified Health Center (FQHC) in order to identify women eligible for genetic counseling (GC). A 12-month usual care phase was followed by a 12-month enrollment phase, during which cancer genetic risk assessment (CGRA) was systematically performed for all women age 25–69 years presenting for an annual exam. Women eligible for GC were recruited to participate in the study. Results After initiating CGRA, 112 women eligible for GC consented to study participation, and 56% of them received a referral for counseling from their PCP. A subgroup of 50 participants were seen by the same PCP during both the usual care and the enrollment phases. None of them were referred for counseling during usual care, compared to 64% after initiation of CGRA (p< 0.001). Only 16% of referred participants attended a GC session. Conclusion Implementing USPSTF recommendations for CGRA as a standard component of primary healthcare is feasible in FQHCs and improves referral of minority women for genetic counseling, but more work is needed to understand the beliefs and barriers that prevent many underserved women from accessing cancer genetic services.

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Evaluation of barriers to referral for cancer predisposition syndromes in pediatric oncology patients in the United States

Venier

Grubs

Kessler

et al. 2022

Journal of Genetic Counseling

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Cancer predisposition syndromes (CPS) are underdiagnosed in the pediatric population, though the diagnosis of a CPS has important implications for the child and their family. CPS are often diagnosed by geneticists or oncologists with expertise in CPS following a malignancy. This requires a member of the care team, most commonly, the treating oncologist to suspect a CPS and refer the patient for CPS assessment. An online survey was distributed to members of the Children's Oncology Group to elucidate current referral practices and barriers to referral for patients suspected to have a CPS. Of the 183 respondents, 86.1% was pediatric oncologists and most (68.5%) used formal guidelines to aid in assessment. Most respondents indicated they would rarely refer patients with tumors highly associated with CPS for genetic assessment. Participants were more likely to refer patients with malignancy and additional features of a CPS than for a specific type of cancer, despite the use of guidelines. Parent knowledge of family history was considered the most challenging barrier to obtaining a family history, though a thorough pedigree was not consistently elicited. Providers indicated the most significant barrier to referral for CPS assessment was priority given the patient's immediate care needs. Identification of these barriers provides direction to focus efforts to increase referrals. Provider education about CPS, clear referral guidelines, and implementation of or increased collaboration with a genetic counselor in the pediatric oncology clinic may encourage CPS assessment and enable oncologists to focus on the patient's immediate care needs.

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Cancer Genetic Risk Assessment and Referral Patterns in Primary Care

Cited by 58 publications

References 31 publications

Primary-care providers’ perceived barriers to integration of genetics services: a systematic review of the literature

Primary-care providers’ perceived barriers to integration of genetics services: a systematic review of the literature

A feasibility study of breast cancer genetic risk assessment in a federally qualified health center

Evaluation of barriers to referral for cancer predisposition syndromes in pediatric oncology patients in the United States

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