Table 5.
Physician Discussion and Recommendations Regarding Genetic Counseling, Genetic Tests, and ELSI, Sorted by Combined Frequency of Occurrence*
| Topic | Control (n = 61) |
Intervention (n = 60) |
Combined (n = 121) |
P† |
|---|---|---|---|---|
| Benefits and referral | ||||
| Benefits of genetic counseling | 37 (60.7 %) | 47 (78.3 %) | 84 (69.4 %) | 0.05 |
| Offers genetic counseling referral | 32 (52.5 %) | 34 (56.7 %) | 66 (54.6 %) | 0.72 |
| Cost discussions | ||||
| Insurance coverage for testing | 22 (36.1 %) | 18 (30.0 %) | 40 (33.1 %) | 0.56 |
| Cost of office genetic test | 16 (26.2 %) | 19 (31.7 %) | 35 (28.9 %) | 0.55 |
| Cost of genetic counseling (including insurance coverage) | 3 (4.9 %) | 5 (8.3 %) | 8 (6.6 %) | 0.49 |
| Testing recommendations | ||||
| Sister should be tested first before SP makes a testing decision | 23 (37.7 %) | 33 (55.0 %) | 56 (46.3 %) | 0.07 |
| SP should “think about it” and then revisit the physician | 22 (36.1 %) | 16 (26.7 %) | 38 (31.4 %) | 0.33 |
| SP should make testing decision after genetic counseling visit | 13 (21.3 %) | 23 (38.3 %) | 36 (29.8 %) | 0.05 |
| Testing expectations and concerns | ||||
| Asks what SP would do if she received a positive BRCA test result | 27 (44.3 %) | 32 (53.3 %) | 59 (48.8 %) | 0.37 |
| Asks the SP for her expectations for screening and/or today’s visit | 9 (14.8 %) | 14 (23.3 %) | 23 (19.0 %) | 0.26 |
| Asks how SP would feel if she received a positive BRCA test result | 4 (6.6 %) | 10 (16.7 %) | 14 (11.6 %) | 0.10 |
| Response to, “what would you do?” ‡ | ||||
| I would get tested | 33 (54.1 %) | 20 (33.3 %) | 53 (43.8 %) | 0.03 |
| It’s up to you. / Only you can decide. | 14 (23.0 %) | 24 (40.0 %) | 38 (31.4 %) | 0.052 |
| I don’t know | 2 (3.3 %) | 5 (8.3 %) | 7 (5.8 %) | 0.27 |
| I would not get tested | 0 (0.0 %) | 3 (5.0 %) | 3 (2.5 %) | 0.12 |
| ELSI for the SP | ||||
| Confidentiality of the medical record | 31 (50.9 %) | 34 (56.7 %) | 65 (53.7 %) | 0.59 |
| Health insurance discrimination | 32 (52.5 %) | 32 (53.3 %) | 64 (52.9 %) | 1.0 |
| Federal legal protections (GINA) | 35 (57.4 %) | 26 (43.3 %) | 61 (50.4 %) | 0.15 |
| Life insurance discrimination | 30 (49.2 %) | 30 (50.0 %) | 60 (49.6 %) | 1.0 |
| Employment discrimination | 11 (18.0 %) | 9 (15.0 %) | 20 (16.5 %) | 0.82 |
| Stigma as a social issue | 0 (0.0 %) | 0 (0.0 %) | 0 (0.0 %) | ─ |
| ELSI for family members | ||||
| Life insurance discrimination | 1 (1.6 %) | 1 (1.7 %) | 2 (1.7 %) | 1.0 |
| Health insurance discrimination | 1 (1.6 %) | 0 (0.0 %) | 1 (0.8 %) | 1.0 |
| Confidentiality of the medical record | 1 (1.6 %) | 0 (0.0 %) | 1 (0.8 %) | 1.0 |
| Employment discrimination | 0 (0.0 %) | 0 (0.0 %) | 0 (0.0 %) | ─ |
| Federal legal protections (GINA) | 0 (0.0 %) | 0 (0.0 %) | 0 (0.0 %) | ─ |
| Stigma as a social issue | 0 (0.0 %) | 0 (0.0 %) | 0 (0.0 %) | ─ |
ELSI ethical, legal, and social issues
* Values reported are the numbers (percentages) of physicians who raised the topic or made the specific statement during the visit.
† Probability values are based on Fisher’s exact test.
‡Numbers for this grouping need not sum to 100 %. A physician could ignore the query or respond in a manner not represented by our codes.