Family Physician Self-Efficacy With Screening for Inherited Cancer Risk

Abstract

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 ...

Familial Risk of Cancer and Knowledge and Use of Genetic Testing

“…4 Barriers to the collection of family history include lack of time during a typical visit, as well as the concerns of clinicians about their ability to use this information to accurately counsel patients about their personal risk. 5,6 In addition, patient barriers are important in the communication of family history to clinicians. According to a survey conducted by the Centers for Disease Control (CDC), most Americans report that they have not actively collected health information from their relatives to develop a family history.…”

Self-rated breast cancer risk among women reporting a first-degree family history of breast cancer on office screening questionnaires in routine medical care: The role of physician-delivered risk feedback

“…Categorizing the clinical relevance of family cancer history is challenging given low levels of physician confidence in pedigree analysis 3 and guidelines for establishing whether one's family history should trigger nonstandard approaches to breast cancer prevention are not uniform in their determination of high risk status. 17 Given that substantial medico-legal pressures related to missed or delayed diagnoses of breast cancer impact primary Table 2 Crude and adjusted estimates of association between regular physician feedback within past year and self-rated risk status care physicians, 18,19 physicians harboring any ambiguity about their patient's family history of breast cancer are likely to favor more versus less aggressive recommendations about preventive interventions.…”

“…2 These and related recommendations reinforce the clinical use of family history in primary care practice for the purposes of shared decision-making about breast cancer prevention strategies, including pursuit of genetic testing. Despite the evidence suggesting that primary care physicians lack confidence in the assessment of heritable cancer risk, 3 most of the decision-making about whether one's family history is clinically relevant or not will take place in the primary care setting. Little is known about whether, and how, handling of family history in primary care influences a patient's perceptions of her breast cancer risk.…”

The Future of Family Medicine? Reflections from the Front Lines Reveal Frustration and Opportunity

“…The study fi nding low levels of reported physician effectiveness in screening for inherited cancer risk 31 brought a refl ective commentary on why we don't consistently do what we are "supposed" to do. 32 Two family physician genetics researchers urge us either to seize the "teachable moment" to incorporate genetics into our practices 33 or to do more research to understand how to do this effectively.…”