Factors influencing cancer genetic somatic mutation test ordering by cancer physician

Demeshko, Anastassia; Pennisi, David J.; Narayan, Sushil; Gray, Stacy W.; Brown, Matthew A.; McInerney-Leo, Aideen

doi:10.1186/s12967-020-02610-7

Cited by 12 publications

(10 citation statements)

References 25 publications

(47 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Lowest confidence was reported for tasks related directly to genetic testing and counselling, such as ordering tests and interpreting the results. These findings are congruent with similar surveys of GPs, oncologists (Demeshko et al, 2020) and obstetricians/gynaecologists (Nippert et al, 2011b). According to the COM-B model, failure to address the low confidence in genetic tasks would negatively affect successful uptake of providing genetic testing by clinicians.…”

Section: Discussionsupporting

confidence: 90%

Attitudes of Australian dermatologists on the use of genetic testing: A cross-sectional survey with a focus on melanoma

et al. 2022

Self Cite

View full text Add to dashboard Cite

Background: Melanoma genetic testing reportedly increases preventative behaviour without causing psychological harm. Genetic testing for familial melanoma risk is now available, yet little is known about dermatologists’ perceptions regarding the utility of testing and genetic testing ordering behaviours.Objectives: To survey Australasian Dermatologists on the perceived utility of genetic testing, current use in practice, as well as their confidence and preferences for the delivery of genomics education.Methods: A 37-item survey, based on previously validated instruments, was sent to accredited members of the Australasian College of Dermatologists in March 2021. Quantitative items were analysed statistically, with one open-ended question analysed qualitatively. Results: The response rate was 56% (256/461), with 60% (153/253) of respondents between 11 and 30 years post-graduation. While 44% (112/252) of respondents agreed, or strongly agreed, that genetic testing was relevant to their practice today, relevance to future practice was reported significantly higher at 84% (212/251) (t = -9.82, p < 0.001). Ninety three percent (235/254) of respondents reported rarely or never ordering genetic testing. Dermatologists who viewed genetic testing as relevant to current practice were more likely to have discussed (p < 0.001) and/or offered testing (p < 0.001). Respondents indicated high confidence in discussing family history of melanoma, but lower confidence in ordering genetic tests and interpreting results. Eighty four percent (207/247) believed that genetic testing could negatively impact life insurance, while only 26% (63/244) were aware of the moratorium on using genetic test results in underwriting in Australia. A minority (22%, 55/254) reported prior continuing education in genetics. Face-to-face courses were the preferred learning modality for upskilling.Conclusion: Australian Dermatologists widely recognise the relevance of genetic testing to future practice, yet few currently order genetic tests. Future educational interventions could focus on how to order appropriate genetic tests and interpret results, as well as potential implications on insurance.

show abstract

Section: Discussionsupporting

confidence: 90%

Attitudes of Australian dermatologists on the use of genetic testing: A cross-sectional survey with a focus on melanoma

et al. 2022

Self Cite

View full text Add to dashboard Cite

show abstract

“…However, another possibility may be that healthcare personnel are uncomfortable dealing with genetic testing and the resulting findings. Numerous studies have shown that healthcare personnel, especially in the primary care setting, do not feel adequately equipped to order genetic tests or interpret, communicate, and follow up on such results ( Overby et al, 2014 ; George et al, 2015 ; Hamilton et al, 2017 ; Hann et al, 2017 ; Briggs et al, 2018 ; Hauser et al, 2018 ; Laforest et al, 2019 ; Menko et al, 2019 ; Demeshko et al, 2020 ). Reservations regarding insurance discrimination and the social impact the findings might have for the patient play a role as well, although we note that only one person in the results herein asked to have no mention of the finding in the medical record.…”

Section: Discussionmentioning

confidence: 99%

Incomplete Penetrance of Population-Based Genetic Screening Results in Electronic Health Record

et al. 2022

View full text Add to dashboard Cite

The clinical value of population-based genetic screening projects depends on the actions taken on the findings. The Healthy Nevada Project (HNP) is an all-comer genetic screening and research project based in northern Nevada. HNP participants with CDC Tier 1 findings of hereditary breast and ovarian cancer syndrome (HBOC), Lynch syndrome (LS), or familial hypercholesterolemia (FH) are notified and provided with genetic counseling. However, the HNP subsequently takes a “hands-off” approach: it is the responsibility of notified participants to share their findings with their healthcare providers, and providers are expected to implement the recommended action plans. Thus, the HNP presents an opportunity to evaluate the efficiency of participant and provider responses to notification of important genetic findings, using electronic health records (EHRs) at Renown Health (a large regional hospital in northern Nevada). Out of 520 HNP participants with findings, we identified 250 participants who were notified of their findings and who had an EHR. 107 of these participants responded to a survey, with 76 (71%) indicating that they had shared their findings with their healthcare providers. However, a sufficiently specific genetic diagnosis appeared in the EHRs and problem lists of only 22 and 10%, respectively, of participants without prior knowledge. Furthermore, review of participant EHRs provided evidence of possible relevant changes in clinical care for only a handful of participants. Up to 19% of participants would have benefited from earlier screening due to prior presentation of their condition. These results suggest that continuous support for both participants and their providers is necessary to maximize the benefit of population-based genetic screening. We recommend that genetic screening projects require participants’ consent to directly document their genetic findings in their EHRs. Additionally, we recommend that they provide healthcare providers with ongoing training regarding documentation of findings and with clinical decision support regarding subsequent care.

show abstract

“…One qualitative study showed that healthcare providers believed experience working with genomics increased genomic confidence levels [ 38 ]. In Australia, a study showed that the frequency with which cancer physicians ordered genetic testing was associated with increased genomic confidence levels, however, it was unclear whether genomic confidence was a cause or effect of test ordering behaviour [ 26 ]. Similarly, a study in the United States reported genetic test ordering to be a key predictor of genomic confidence in family physicians [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

Australian human research ethics committee members’ confidence in reviewing genomic research applications

et al. 2021

Self Cite

View full text Add to dashboard Cite

Human research ethics committees (HRECs) are evaluating increasing quantities of genomic research applications with complex ethical considerations. Genomic confidence is reportedly low amongst many non-genetics-experts; however, no studies have evaluated genomic confidence levels in HREC members specifically. This study used online surveys to explore genomic confidence levels, predictors of confidence, and genomics resource needs of members from 185 HRECs across Australia. Surveys were fully or partially completed by 145 members. All reported having postgraduate 94 (86%) and/or bachelor 15 (14%) degrees. Participants consisted mainly of researchers (n = 45, 33%) and lay members (n = 41, 30%), affiliated with either public health services (n = 73, 51%) or public universities (n = 31, 22%). Over half had served their HREC 3 years. Fifty (44%) reviewed genomic studies 3 times annually. Seventy (60%) had undertaken some form of genomic education. While most (94/103, 91%) had high genomic literacy based on familiarity with genomic terms, average genomic confidence scores (GCS) were moderate (5.7/10, n = 119). Simple linear regression showed that GCS was positively associated with years of HREC service, frequency of reviewing genomic applications, undertaking self-reported genomic education, and familiarity with genomic terms (p < 0.05 for all). Conversely, lay members and/or those relying on others when reviewing genomic studies had lower GCSs (p < 0.05 for both). Most members (n = 83, 76%) agreed further resources would be valuable when reviewing genomic research applications, and online courses and printed materials were preferred. In conclusion, even well-educated HREC members familiar with genomic terms lack genomic confidence, which could be enhanced with additional genomic education and/or resources.

show abstract

Factors influencing cancer genetic somatic mutation test ordering by cancer physician

Cited by 12 publications

References 25 publications

Attitudes of Australian dermatologists on the use of genetic testing: A cross-sectional survey with a focus on melanoma

Attitudes of Australian dermatologists on the use of genetic testing: A cross-sectional survey with a focus on melanoma

Incomplete Penetrance of Population-Based Genetic Screening Results in Electronic Health Record

Australian human research ethics committee members’ confidence in reviewing genomic research applications

Contact Info

Product

Resources

About