Motivations and concerns of patients considering participation in an implementation study of a hereditary cancer risk assessment program in diverse primary care settings

Abstract

Understanding the motivations and concerns of patients from diverse populations regarding participation in implementation research provides the needed evidence about how to design and conduct studies for facilitating access to genetics services. Within a hereditary cancer screening study assessing a multifaceted intervention, we examined primary care patients' motivations and concerns about participation. Methods: We surveyed and interviewed study participants after they enrolled, surveyed those who did not complete enrollment, and used descriptive qualitative and quantitative methods to identify motivations and concerns regarding participation. Results: Survey respondents' most common motivations included a desire to learn about their future risk (81%), receiving information that may help family (58%), and a desire to advance research (34%). Interviews revealed 3 additional important factors: affordability of testing, convenience of participation, and clinical relationships supporting research decision-making. Survey data of those who declined enrollment showed that the reasons for declining included concerns about privacy (38%), burdens of the research (19%), and their fear of not being able to cope with the genetic information (19%). Conclusion: Understanding the facilitating factors and concerns that contribute to decisions about research may reveal ways to improve equity in access to care and research that could lead to greater uptake of genomic medicine across diverse primary care patient populations.

Effects of cancer type and sex on genetic testing for clinician recommendation and uptake

“…This cross-sectional survey found that males were less likely to receive a recommendation for genetic testing and less likely to complete genetic testing than females adjusting for con-founders and cancer type, similar to Vysotskaia et al [23]. Additionally, consistent with prior research, clinician recommendation strongly associated with completing genetic testing amongst both sexes [4,8,23,31].…”

Primary Care Implications of the Expanded National Guidelines for Germline Testing of Patients Previously Diagnosed with Colorectal Cancer

“…20 The NCCN guidelines were also expanded because patients wish to know if they carry PGVs. 21 In the primary care clinic setting, Duenas et al 21 reported that surveyed patients wished to have testing to learn of their future risk (81%), particularly if the information might help family members (58%) and advance research (34%). In fact, Halverson et al 22 reported that 67% of patients who initially declined testing at the time of the initial evaluation said either they would or had changed their mind about testing if/when the clinicians "mentioned it again.…”