Catalogue of barriers to genetic literacy, referral, and counselling, as identified by surgeons within included studies
| Study number | Barriers | Type of barrier |
|---|---|---|
| 2 | Ease of insurance approval, ease of referral to a genetic counsellor, and patient compliance | System, patient |
| a) Ease of insurance approval “is burdensome, but we get it done,” according to 58% of surgeons; 26% felt it was “easy and straightforward” to obtain insurance approval of genetic testing for their patients, 9% considered insurance “too burdensome for us to deal with in our setting,” and 7% said approval was “often denied” | ||
| b) Ease of referral to a genetic counsellor: 51% reported easy local access, 17% provided own clinic counselling, 3% consulted genetic counsellor by telephone, 16% felt it was a “burdensome” process, 14% felt local access was “inadequate” | ||
| c) Patient compliance with genetic counsellor appointment: 61% reported patients attend appointment > 50% of time, and 22% reported their patients fail to keep appointments > 50% of time | ||
| 3 | Survey respondents suggest changes to Ontario cancer genetics program: increased provider education and awareness, and public awareness; broadened criteria for access; increased provider autonomy (i.e., order genetic tests themselves); and increased access, availability, and resources (rural, timeliness, more clinics) | System |
| a) 40% of surgeons and 56% of surgical oncologists are satisfied with availability of cancer genetics clinics in area | ||
| b) 39% of surgeons and 18% of surgical oncologists are satisfied with timeliness of referral appointments with cancer genetics clinics | ||
| c) 23% of surgeons and 6% of surgical oncologists are satisfied with timeliness of genetic testing results | ||
| d) 68% of surgeons and 69% of surgical oncologists are satisfied with quality of the referral letters from genetic counsellors | ||
| 4 | Lack of time during busy clinics | Surgeon |
| 5 | Decision of which provider should order genetic testing for incorporating testing in multidisciplinary care | Surgeon |
| 9 | Little contact between interprofessional teams impede communication about mainstreaming (i.e., surgeons and clinical genetics teams rarely met and did not know each other well) | Surgeon, system |
| Lack of comprehensive guidelines detailing how patients should be managed | ||
| 14 | Variation in surgeon attitude about genetic testing and counselling associated with receipt of genetic testing after breast cancer diagnosis | Surgeon |
| 16 | Poor understanding of the current guidelines among clinicians and variable clinical pathways for patients; also, a perception that another unspecified clinician is undertaking this work | Surgeon, system |