Knowledge and opinions regarding BRCA1 and BRCA2 genetic testing among primary care physicians

Abstract

BRCA1 and BRCA2 (BRCA1/2) testing is standard for individuals with personal and/or family history suggestive of hereditary breast and ovarian cancer syndrome. The indications for testing have been expanding. To accommodate the need, incorporation of cancer genetic services into the practice of non‐genetic healthcare providers should be considered. We carried out a survey to evaluate the knowledge and opinions regarding BRCA1/2 testing among primary care providers. The survey was sent to 245 Obstetrics/Gynecology and 97 Family Medicine physicians in the UPMC network. Eighty‐six completed the survey between July 2015 and September 2015. The average correct responses to knowledge questions was 73%. A few respondents reported being completely confident, and ~50% reported being somewhat confident, in providing BRCA1/2‐related information. Respondents selected genetic specialists and oncologists as the most qualified to provide cancer genetic services. Several perceived barriers and motivating factors to the implementation of BRCA1/2 testing in primary care were identified. The findings from this study suggested that primary care providers were not uniformly ready to provide BRCA1/2 genetic testing. Availability of professional society guidelines and evidence of testing's usefulness might motivate the incorporation of BRCA1/2 genetic testing into primary care practices. These findings would help guide future educational efforts to promote provision of cancer genetic services by non‐genetic professionals.

Primary Care Physician Experiences with Integrated Population-Scale Genetic Testing: A Mixed-Methods Assessment

“…The majority of PCPs desired additional education and resources on these topics, likely due to their reported lack of confidence. These findings add to the existing literature which indicates PCPs need further education in order to successfully integrate genetics into their clinical practice [3,[5][6][7][8][9][10]14]. It is likely that effective genomic education will need to be tailored to individual provider learning preferences and by specialty [32] and/or be made available to PCPs at the point of care.…”

“…Several of our findings are consistent with previous studies exploring PCP perspectives towards incorporating genomic medicine into their practice. Previous qualitative and quantitative studies have identified a lack of PCP confidence in their genetics knowledge as a barrier to incorporating genetics into their practices [3][4][5][6][7][8][9][10]. These studies report PCP confidence in their knowledge of various aspects of genomics to be between 15% and 50% [3][4][5][6][7]9].…”

“…Previous qualitative and quantitative studies have identified a lack of PCP confidence in their genetics knowledge as a barrier to incorporating genetics into their practices [3][4][5][6][7][8][9][10]. These studies report PCP confidence in their knowledge of various aspects of genomics to be between 15% and 50% [3][4][5][6][7]9]. Similarly, in the present study, only half of PCPs surveyed about the DNA-10K reported confidence in discussing the risks and benefits of testing, explaining results and articulating next steps to their patients.…”

“…Research conducted over the past several years has explored non-genetics providers' views and perceived barriers related to integrating genomics into their practice. Several studies show that the majority of non-genetics providers report low confidence in genetic concepts, testing and interpretation of results [3][4][5][6][7][8][9][10][11]. High levels of confidence as to when to refer to a genetic specialist have been reported [12], though this was lower in primary care providers (PCPs) than specialty providers.…”

“…Specifically, non-genetics providers cite challenges related to genomic terminology and the volume of information in genetic laboratory reports [13]. In the context of these knowledge and confidence gaps, specific areas for further education have been identified, including how to interpret results [14] and manage uncertain findings [3]. The value of genetic specialist availability for referral or consultation has been highlighted and a need to clarify the role of non-genetics providers has been suggested [14].…”