Key findings of perceptions and attitudes pertaining to genetic literacy among surgeons within included studies
| Study number | Perceptions about and attitudes toward genetic referral, testing, and counselling |
|---|---|
| 1 | Assessed the perceived value and usefulness of treatment-focused genetic testing for treatment and management of breast cancer, the perceived impact of treatment-focused genetic testing on treatment decision-making, and preference for best professional to make initial offer of treatment-focused genetic testing |
| a) 25.1% of surgeons agreed treatment-focused genetic testing is useful for patient care, treatment, and management | |
| b) 11.0% of surgeons strongly agreed or agreed genetic knowledge has impact on treatment decision-making | |
| c) The best professional to make initial treatment-focused genetic testing offer should be surgeon (66.7%), genetic counsellor (25%), oncologist (8.3%), and breast care nurse (0%) | |
| 2 | Assessed breast cancer surgeon skill and practice in BRCA test counselling and desire for education |
| a) 54.0% of surgeons ordered their own BRCA testing | |
| b) 51.6% provided pre- and post-BRCA test counselling as standard practice, 36.6% of surgeons reported another provider usually does counselling, 11.8% of surgeons not confident in counselling | |
| c) 63.3% obtain ≥ 3-generation pedigree family history from patients as standard practice | |
| d) 39% had ordered expanded genetic mutation panels | |
| e) 85% strongly agree or agree they would like educational support in genetic testing | |
| 3 | Assessed use of cancer genetics service and satisfaction with cancer genetics program (timeliness of testing results, availability of clinics, quality of referral letters) |
| a) 70% of surgeons and 94% of surgical oncologists have referred to hereditary cancer genetic services in the past or had previous contact with them | |
| b) 63% of surgeons and 94% of surgical oncologists have referred to genetic counselling in the past year | |
| c) During the past year, surgeons referred 5 ± 6 people, and surgical oncologists referred 11 ± 9 for genetic counselling regarding hereditary cancer | |
| d) 23%–25% of surgeons and 11% of surgical oncologists satisfied with notification of availability of genetic testing for hereditary breast, ovarian, and colorectal cancer by Ontario Ministry of Health and Long-Term Care | |
| 4 | Gaps identified included extent of discussion of family history and genetic counselling with patients, sufficient history for optimal referral for genetic testing, and lack of knowledge in genetics |
| 5 | Assessed perception of clinical utility of Oncotype DX, perception about impact of patient preference, and communication of test results (risk) to patients |
| a) All surgeons believed surgeons ordering tests facilitated care and minimized delays: “arranging for the testing to happen as soon as possible, ideally ordered around the time of surgery in order to expedite receipt of the results has been our practice pattern” | |
| b) Perception of impact: 95% of oncologists reported patients’ preferences for chemotherapy affected both the decision to order testing and how the results would be used | |
| c) Risk communication: “My other concern is that the intermediate score is very difficult to explain to a patient” | |
| 6 | Examined provider awareness of Bethesda criteria and features of Lynch syndrome and counselling and referral practices |
| a) 93% of surgeons would refer to regional genetic service after positive immunohistochemistry | |
| b) 83% of surgeons discuss screening and surveillance with patient after positive immunohistochemistry result | |
| 7 | Studied timing, ordering, and discussion of genetic testing, and surgeon confidence in discussing testing |
| a) Surgeon orders genetic testing without referring to counsellor: 26% (1–20 patients/yr), 35% (21–50 patients/yr), 37% (>_50 patients/yr) | |
| b) Surgeon does not delay surgery for test results: 38% (1–20 patients/yr), 27% (21–50 patients/yr), 17% (>_50 patients/yr) | |
| c) Will offer breast-conserving surgery in patient with BRCA1 or BRCA2 mutation: 36% (1–20 patients/yr), 25% (21–50 patients/yr), 43% (> 50 patients/yr) | |
| d) Would manage a patient with variant of uncertain significance same as BRCA1 or BRCA2 mutation carrier: 50% (1–20 patients/yr), 42% (21–50 patients/yr), 24% (>_50 patients/yr) | |
| e) Confidence in discussing testing: 73% in surgeons with higher volume (>_51 breast cancer patients/yr) and 35% with lower volume (1–20 patients/yr) of breast cancer | |
| 8 | Described surgeon comfort in counselling patients regarding genetic inheritance pattern of Lynch syndrome, available genetic tests, criteria for genetic testing, and current consensus recommendation for colorectal cancer and endometrial cancer screening in patients with Lynch mutation |
| a) 52% comfortable in counselling on Lynch syndrome genetic inheritance pattern | |
| b) 21% comfortable in counselling on Lynch syndrome available genetic testing | |
| c) 63% comfortable in counselling on Lynch syndrome criteria for genetic testing | |
| d) 21% comfortable in counselling on Lynch syndrome endometrial cancer screening | |
| e) 63% comfortable in counselling on Lynch syndrome colon cancer screening | |
| 9 | Described surgical team’s perceptions of mainstreaming: |
| a) Perception of role responsibility in treating cancer: “We don’t have the time or skills to counsel people about gene testing” | |
| b) Redesigning the care pathway: mainstreaming treatment-focused genetic testing will increase workload beyond capacity | |
| c) Relevance for practice: treatment-focused genetic testing less relevant for surgical practice | |
| 10 | Outlined surgeon attitudes regarding referral of patients to RGCT |
| a) Surgeon attitudes regarding referral of patients RGCT (I consider the possibility of referral for RGCT as important) 81.3% at start v. 93.8% at end of study | |
| b) Surgeon attitudes regarding referral of patients RGCT (I consider RGCT as burdensome for the patient) 31.3% v. 43.8% | |
| c) Surgeon attitudes regarding referral of patients RGCT (The advantages of RGCT outweigh the disadvantages for the professional) 68.8% v. 75% | |
| d) Surgeon attitudes regarding referral of patients RGCT (The advantages of RGCT outweigh the disadvantages for the patient) 81.3% v. 60% | |
| 11 | Described breast surgeons’ attitude toward practice responsibilities:
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| 12 | Most surgeons discussed hereditary cancer syndromes and genetic testing with their patients (94.4% frequently or occasionally) and more than half (60.4%) had personally ordered genetic testing, although it is unknown whether any counselling, either by the surgical oncologist or a genetics counsellor, was provided before testing |
| 13 | Assessed surgeons’ perception of barriers and facilitators to genetic testing among African American women with moderate to high risk; themes identified were as follows:
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| 14 | Tendency to order genetic testing, surgeon’s confidence in discussing genetic testing with patients, surgeon’s annual patient volume, and patient factors (race and ethnicity, insurance status) |
| a) The odds of a patient receiving genetic testing would increase more than twofold (odds ratio 2.48, 95% CI 1.85–3.31) if she saw a surgeon with a genetic test ordering rate that was 1 SD above that of a surgeon with the mean test rate (independent of the patient’s pretest risk of mutation carriage) | |
| b) The odds of testing being ordered increased by 1.88 (95% CI 1.49–2.38) for each 1-SD increase in the scale score for surgeon volume | |
| c) Patients with no or public insurance or Black ethnicity were less likely to get tested | |
| 16 | Surgeons were the only specialty with most answering that they had responsibility for managing patients with colorectal cancer with elevated inherited risk |
CI = confidence interval; RGCT = rapid genetic counselling and testing; SD = standard deviation.