Impact of a Randomized Controlled Educational Trial to Improve Physician Practice Behaviors Around Screening for Inherited Breast Cancer

Abstract

BACKGROUND: Many primary care physicians (PCPs) are ill-equipped to provide screening and counseling for inherited breast cancer. OBJECTIVE: To evaluate the outcomes of an interactive web-based genetics curriculum versus text curriculum for primary care physicians. DESIGN: Randomized two-group design. PARTICIPANTS: 121 California and Pennsylvania community physicians. INTERVENTION: Web-based interactive genetics curriculum, evaluated against a control group of physicians who studied genetics review articles. After education, physicians interacted with an announced standardized patient (SP) at risk for inherited breast cancer. MAIN MEASURES: Transcripts of visit discussions were coded for presence or absence of 69 topics relevant to inherited breast cancer. KEY RESULTS: Across all physicians, history-taking, discussions of test result implications, and exploration o f e t h i c a l a n d l e g a l i s s u e s w e r e i n c o m p l e t e . Approximately half of physicians offered a genetic counseling referral (54.6 %), and fewer (43.8 %) recommended testing. Intervention physicians were more likely than controls to explore genetic counseling benefits (78.3 % versus 60.7 %, P= 0.048), encourage genetic counseling before testing (38.3 % versus 21.3 %, P= 0.048), ask about a family history of prostate cancer (25.0 % versus 6.6 %, P= 0.006), and report that a positive result indicated an increased risk of prostate cancer for male relatives (20.0 % versus 1.6 %, P= 0.001). Intervention-group physicians were less likely than controls to ask about Ashkenazi heritage (13.3 % versus 34.4 %, P= 0.01) or to reply that they would get tested when asked, "What would you do?" (33.3 % versus 54.1 %, P= 0.03). CONCLUSIONS: Physicians infrequently performed key counseling behaviors, and this was true regardless of whether they had completed the web-based interactive training or read clinical reviews.

Primary care providers’ cancer genetic testing-related knowledge, attitudes, and communication behaviors: A systematic review and research agenda

“…31,33,34,39,41,45,52,54,57 Of these, four studies provided descriptive information about PCPs' experiences discussing genetic risk and testing (2 relying on surveys in the breast cancer context 41,45 and 1 using mixed-methods in the prostate cancer context 33 ). The other used a novel study design featuring standardized patients to evaluate communication behaviors among 86 providers and found that in only 21% and 3% of encounters did providers express opinions suggesting that patients at high maternal or paternal breast cancer risk, respectively, were candidates for genetic testing.…”

“…31,52,57 For instance, as noted, Scheuner and colleagues evaluated a multicomponent cancer genetics toolkit targeted at providers that improved their discussion and documentation of cancer family history and appropriate patient referrals for genetic consultation. 52 Another study evaluated an educational intervention among 121 primary care physicians and found that some communication behaviors improved (e.g., 78% of intervention physicians explored genetic counseling benefits with a standardized patient versus 61% of controls); however, the intervention did not lead to significant differences in the offering of a genetic counseling referral or recommending of genetic testing.…”

“…52 Another study evaluated an educational intervention among 121 primary care physicians and found that some communication behaviors improved (e.g., 78% of intervention physicians explored genetic counseling benefits with a standardized patient versus 61% of controls); however, the intervention did not lead to significant differences in the offering of a genetic counseling referral or recommending of genetic testing. 31 …”

Supporting genetics in primary care: investigating how theory can inform professional education

“…Family physicians (FPs) are often considered to be in an ideal position to provide initial genetic risk assessment and counselling to patients, and studies over more than a decade suggest that practitioners themselves agree that this is an appropriate role. 1, 2, 3, 4, 5, 6, 7 However, there is little evidence that FPs are actually integrating genetic case finding into their practices, 7, 8, 9, 10 and primary care may be poorly prepared for the expansion of genomics technologies, and changing patient expectations.…”

Capsule Commentary on Bell et al., Impact of a Randomized Control Educational Trial to Improve Physician Practice Behaviors Around Screening for Inherited Breast Cancer

“…There were few differences between intervention groups. 2 While disappointing, the study's findings suggest several ways forward. The authors compiled an extensive list of 69 tasks important to comprehensive counseling.…”