Hereditary cancer screening attitudes and practices among primary care providers: A mixed-methods study

Abstract

Purpose: Across the United States nationally recommended strategies for identifying asymptomatic individuals with predispositions to hereditary cancer syndromes are severely underutilized. The long term doctor-patient relationship between primary care providers (PCPs) and their patients makes them uniquely positioned to carry out such testing, but historically PCPs report being unknowledgeable about these topics. This study aims to 1) describe how much confidence PCPs have conducting clinical cancer consultations, 2) identify PCPs’ current practices for obtaining their patients’ personal and familial cancer histories, and to 3) understand how PCPs use their patients’ personal and familial histories of cancer to inform their ordering of genetic testing.Methods: An online survey was distributed and follow up semi-structured interviews were conducted among a group of PCPs located throughout Washington, Wyoming, and Montana. Binary logistic regression analyses were used to explore the relationship between background variables and the PCPs’ confidence scores. Interview transcripts were analyzed via a directed content analysis approach. Results: The regression analyses showed that PCPs who practiced in more urban rural urban continuum codes (RUCC) and scored higher on the Consolidated Framework for Implementation Research (CFIR) self-efficacy subscale were more likely to have higher confidence levels with respect to initiating the conversation about cancer risk and responding to their patients’ questions about cancer risk based on their family history, as well as their confidence in explaining lifetime and age-related cancer risk to their patients. The interview results revealed that most PCPs gather personal and familial cancer history from their patients via a general direct questioning process with the patient in tandem with another method. Most PCPs believe that collecting this information is important primarily because it informs their future cancer screening recommendation. Most PCPs are not ordering cancer risk genetic testing and those that are report they are really only comfortable ordering rather limited range of cancer genetic tests. Conclusions: These results suggest that PCPs recognize the benefits these early identification strategies can provide, but they don’t feel comfortable carrying out the ordering and interpretation of cancer risk genetic testing themselves. On this basis, better educational strategies, alongside implementation of updated procedures and automated prompts in electronic medical records are needed to further aid PCPs in successfully implementing universal screening and testing for predispositions to hereditary cancers in primary care settings.