Oncologists’ Perceptions of Tumor Genomic Profiling and the Communication of Test Results and Risks

Abstract

Tumor genomic profiling (TGP) identifies genetic targets for precision cancer treatments. The complexity of TGP can expose gaps in oncologists’ skills, complicating test interpretation and patient communication. Research on oncologists’ use and perceptions of TGP could inform practice patterns and training needs. To study this, a sample of oncologists was surveyed to assess TGP use, perceptions, and perceived skills in TGP interpretation/communication, especially in communication of hereditary risks. Genomic self-efficacy and TGP knowledge were also assessed. The goal sample (<i>n</i> = 50) was accrued from 12/2019 to 1/2020. Respondents were primarily medical oncologists (78%) with >10 (mean 17.7) years of practice experience. TGP use was moderate/high (median 50 [range 2–398]) tests/year. Most oncologists reported informal/no training in interpretation (72%) or communication (86%) of TGP results and risks. Genomic self-efficacy was high and was associated with higher use of TGP (<i>p</i> = 0.047). Perceptions of the benefits and limitations of TGP were mixed: heterogeneity was seen by years of experience, TGP use, and knowledge. Most participants agreed that additional training in TGP communication was needed, especially in communication of hereditary risks, and that an online training tool would be useful (86%). We conclude that oncologists are frequently using TGP despite having mixed views about its utility and not feeling prepared to communicate risks to patients. Oncologists receive little education in interpreting TGP or communicating its results and risks, and would value training in this area.

An Overview of Comprehensive Genomic Profiling Technologies to Inform Cancer Care

“…6 Health care professionals would ultimately need to translate that information for their patients. Two studies, from the US 73 and Australia, 74 examined the perceptions of oncologists in interpreting genomic profiling information. Participants in both studies revealed that although they felt confident in their understanding of testing, using results to inform treatments, and explaining the technology to patients, they reported less confidence in interpreting more complex findings or information about secondary mutations.…”

“…Participants in both studies revealed that although they felt confident in their understanding of testing, using results to inform treatments, and explaining the technology to patients, they reported less confidence in interpreting more complex findings or information about secondary mutations. 73,74 Oncologists also reported that they would benefit from receiving additional training about interpreting tests results and communicating more complex findings to patients. 73,74 Increased recruitment and additional training for health care professionals specializing in genetics (including oncologists and genetic counsellors) have been recommended in Canada as demand for genetic services continues to increase.…”

“…73,74 Oncologists also reported that they would benefit from receiving additional training about interpreting tests results and communicating more complex findings to patients. 73,74 Increased recruitment and additional training for health care professionals specializing in genetics (including oncologists and genetic counsellors) have been recommended in Canada as demand for genetic services continues to increase. 71 Understanding Patients' Perspectives CGP tests that use liquid biopsy based on fluid samples, such as blood, and are minimally invasive and more accessible than tissue biopsy-based tests.…”

The Role of Medical Mistrust in Concerns about Tumor Genomic Profiling among Black and African American Cancer Patients

“…Future research may also consider investigating whether information about TGP from more trusted health information sources, such as Black and AA healthcare providers, community organizations (e.g., faith-based organizations), and family members [ 68 ], could mitigate the association between medical mistrust and TGP concerns. Finally, one potential strategy for mitigating some of the disparities in cancer outcomes includes improved communication strategies for relaying cancer-related and genetic testing-related information to cancer patients with high medical mistrust and potentially limited health literacy [ 38 ]. For example, researchers have developed tailored methods of communicating more effectively with patients with lower levels of health literacy about TGP [ 69 ], including specialized training programs for health professionals [ 70 ].…”

“…Moreover, higher levels of cancer health literacy are inversely related to number of inpatient hospitalizations and length of hospitalization stays [ 37 ]. However, given the disproportionately lower rates of TGP use among Black and AA cancer patients and the lower levels of genetic literacy, understanding the specific barriers patients face during their cancer treatment should be addressed to close the health disparities gap [ 38 ].…”