Table 2.
Summary of 27 Studies of Primary Care Provider Knowledge, Attitudes, and Communication-Related Behaviors Regarding Cancer Genetic Testing
| Article | Provider type(s) and (sub)sample size | Cancer type(s) | Relevant research questions | Data collection method, relevant outcomes, and measurement |
|---|---|---|---|---|
| Bell et al. 201531 | Primary care physicians (n = 121) | Breast | Does an educational intervention elicit appropriate provider communication behaviors related to HBOC genetic counseling and testing? | Standardized patient case scenarios. C: Standardized patient visits audio-recorded, transcribed, and coded for 69 physician behaviors by 2 coders (average kappa = 0.91) |
| Bellcross et al. 201132 | Family practitioners (n = 515), pediatricians (n = 250), internists (n = 485), OB/GYNs (n = 250) | Breast, ovarian | What are providers’ awareness and use of BRCA1/2 testing? How aware are providers of family history patterns appropriate for BRCA1/2 testing referral? | Survey. K: Providers asked to select indications for BRCA1/2 testing from 7 clinical scenarios representing increased and low-risk situations consistent with USPSTF guidelines |
| Birmingham et al. 201333 | Primary care physicians (n = 10), urologists (n = 9), urology residents (n = 5) | Prostate | What are providers’ attitudes, knowledge, and behavioral intentions regarding DTC genomic testing for prostate cancer risk? | Mixed methods. K, A, C: Single items and multi-item scales*; focus groups coded with grounded theory approach by 2 coders (kappa = 0.77) |
| Burke et al. 200934 | Family practitioners and internists (n = 86) | Breast | What are Seattle/King county providers’ family history-taking and genetic risk assessment skills related to breast cancer? | Standardized patient case scenarios. K, A, C: Standardized patient visits audio-recorded, transcribed, and coded by 2 coders (disagreement resolved by a third coder in ≤2.1% of cases) |
| Chan et al. 201435† | Family practitioners and internists (n = 116), other specialties (e.g., surgery) (n = 24) | Colorectal | What is the impact of provider academic affiliation and training on hereditary colorectal cancer knowledge? | Survey. K: 6 true-false questions consistent with national guidelines and general knowledge about hereditary colorectal cancer derived from literature, vetted by multidisciplinary team |
| Cohn et al. 201536† | Family practitioners and internists (n = 116), other specialties (e.g., surgery) (n = 24) | Breast, ovarian | What is the impact of provider training on HBOC knowledge? | Survey. K: 6 true-false questions consistent with national guidelines about HBOC and genetic testing, vetted by multidisciplinary team |
| Cox et al. 201237 | Family practitioners, internists, NPs, and PAs (n = 363), OB/GYNs (n = 333), naturopaths (n = 216)‡, specialists (n = 297)‡ | Breast, colorectal, ovarian | What are Oregon providers’ levels of knowledge and use of 8 cancer genetic tests? | Survey. K: Single-item measures included in an investigator-designed survey piloted with Oregon healthcare providers |
| Cragun et al. 201338§ | Physicians (n = 53), NPs (n = 25), nurses (n = 2), PAs (n = 1) | Breast, ovarian | What are the BRCA1/2 knowledge, interest, preferences, and facilitators/barriers to cancer genetics education among Florida non-genetics community providers offering BRCA1/2 testing? | Survey. K: 8 multiple-choice and clinical scenario items used to assess knowledge and adherence to national clinical practice guidelines*; survey developed by multidisciplinary team and evaluated for face and content validity |
| Cragun et al. 201639 | NPs (n = 27), OB/GYNs (n = 26), oncologists (n = 22), general surgeons (n = 6), nurses (n = 4), PAs (n = 1), other specialties (n = 5) | Breast, ovarian | What are the HBOC knowledge, practices, and adherence to pretest counseling elements among Florida non-genetics providers offering HBOC genetic testing? | Survey. K, C: Multiple items that were used in a previous survey* along with additional investigator-designed items |
| Frey et al. 201440 | OB/GYNs (n = 50), general surgeons (n = 62)‡ | Colorectal | What is providers’ cancer screening knowledge for women with HNPCC? | Survey. K: Questionnaire developed by the investigators |
| Guerra et al. 200941 | Family practitioners (n = 144), internists (n = 140), OB/GYNs (n = 67) | Breast | What are the prevalence and determinants of the adoption of breast cancer risk assessment by providers? | Survey. K, A, C: Multi-item scales to assess identification of high-risk clinical scenarios, risk assessment beliefs, and physician behaviors as part of an investigator-designed survey |
| Kelly et al. 200942 | Family practitioners (n = 176) | Breast, colorectal | What are the awareness of hereditary cancers and genetic testing experiences of providers in rural and Appalachian practice? | Survey. K, A: Multi-item, internally valid scales and clinical scenarios used as part of an investigator-designed survey |
| Klitzman et al. 201343 | Family practitioners (n = 8), general medicine internists (n = 42), other internist specialties (n = 170) | Breast, colorectal | Do providers order genetic tests for cancer and other disorders for their patients? What factors are associated with these decisions? | Survey. K, A: 44-item questionnaire developed by the investigators based on published literature and clinical experience |
| Lowstuter et al. 200844 | Family practitioners, internists, OB/GYNs, NPs, and medical oncologists (n = 1181) | Breast, colorectal, endometrial | What are Californian non-genetics providers’ perceptions and knowledge of cancer genetics and genetic discrimination laws, attitudes, and referral practices? | Survey. K, A: 47-item survey; items based on a previously validated pilot study* |
| Mainous et al. 201345 ǁ | Family practitioners (n = 1311) | Breast | What are providers’ perceptions and experiences with clinical and DTC genetic testing? | Survey. K, A, C: Investigator-designed items developed from a literature review |
| Menzin et al. 201046 | OB/GYNs (n = 289) | Breast, gynecologic | What are providers’ practice, training, and knowledge of breast health maintenance and cancer screening? | Survey. K: 18-item investigator-designed survey |
| Nair et al. 201547 | Family practitioners (n = 89), internists (n = 51), OB/GYNs (n = 74), NPs and PAs (n = 61) | Breast | What is Georgia providers’ existing HBOC knowledge? | Survey. K: 31-item survey; items adapted by experts from prior national surveys, and beta tested with healthcare providers* |
| Pal et al. 201348 § | OB/GYNs (n = 28), NPs (n = 24), nurses (n = 3), PAs (n = 1), genetic counselors (n = 5)‡, general surgeons (n = 12), medical oncologists (n = 6), other specialties (including internists) (n = 7) | Breast, ovarian | What are the knowledge and practices related to identifying, testing, and managing individuals at risk for BRCA1/2 mutations among Florida providers offering genetic testing? | Survey. K: Multiple-choice and clinical scenario items*; survey developed by multidisciplinary team and evaluated for face and content validity |
| Plon et al. 201149 | OB/GYNs (n = 51), family practitioners (n = 50), internists (n = 48), general surgeons (n = 45), hematology/oncology physicians (n = 31) | Breast | How would Texas non-genetics providers use a cancer patient’s BRCA1/2 results to make genetic testing and risk management recommendations for a healthy at-risk relative? | Survey. K: Investigator-designed case-based descriptions and follow-up questions |
| Ready et al. 201050 | OB/GYN residents (n = 65) | Breast, colorectal, ovarian | What are OB/GYN residents’ family history documentation practices and knowledge of HBOC and HNPCC? | Survey. K: Test adapted from previous studies and evaluated for comprehension at a professional conference* |
| Salz et al. 201251 | Family practitioners (n = 115), internists (n = 20), NPs (n = 13), PAs (n = 6), other (n = 2) | Colorectal | What are providers’ needs for information about colorectal cancer survivorship care? | Survey. K, A: Investigator-designed questionnaire informed by an Institute of Medicine framework for survivorship care plans |
| Scheuner et al. 201452 | Physicians (n = 5), PAs (n = 1), NPs (n = 1) | Breast, colorectal | What is the feasibility and effectiveness of a multi-component cancer genetics toolkit in the women’s primary-care clinics at a large Veterans Administration medical center? | Mixed methods and abstraction from medical records. K, A, C: Investigator-designed survey items developed through literature review, expert opinion, and cognitive testing, plus medical record review |
| Shields et al. 200853 | Family practitioners (n = 616), internists (n = 504) | Breast, colorectal, ovarian | What are providers’ genetic testing experiences, and do experiences differ among minority-serving providers? | Survey. K: Investigator-designed survey informed by focus groups and interviews with healthcare providers, expert feedback, and literature review |
| Vadaparampil et al. 201554 § | Physicians (n = 53), NPs (n = 25), nurses (n = 2), PAs (n = 1) | Breast, ovarian | Do non-genetic providers perform guideline-based intake and informed consent before BRCA1/2 testing? | Survey. C: Multiple items*; survey developed by multidisciplinary team and evaluated for face and content validity |
| White et al. 200855 | Family practitioners (n = 284) | Breast | Are providers’ referral patterns consistent with USPSTF recommendations when a patient requests BRCA1/2 testing? Do patient characteristics influence referrals? | Survey. K, A: Investigator-designed items following a vignette of a hypothetical patient not appropriate for referral to BRCA1/2 genetic services based on USPSTF guidelines |
| Wood et al. 201356 | Family practitioners (n = 14), internists (n = 17), OB/GYNs (n = 9) | Breast, colorectal | What are providers’ perceptions of their role in managing cancer risk based on family history? | Interview/focus groups. K, A: Interviews were audio-recorded and transcribed; data analyzed by 1 coder in collaboration with investigator team |
| Zazove et al. 201557 | Family practitioners (n = 89) | Breast, colorectal | Can tailored electronic medical record prompts about patient family history improve providers’ test/referral ordering? | Abstraction from medical records. C: Manual chart audits conducted by trained auditors who reviewed visit notes, test orders, and referrals |
Note: Providers = Primary care providers; K = knowledge; A = attitudes; C = communication-related behaviors; OB/GYNs = obstetricians/gynecologists; NPs = nurse practitioners; PAs = physician assistants, HBOC = hereditary breast and ovarian cancer; DTC = direct-to-consumer; HNPCC = hereditary nonpolyposis colorectal cancer; USPSTF = United States Preventive Services Task Force
*Relevant outcomes were assessed with measures used and/or validated in prior research; see original publication for details
†Studies report on the same sample
‡Findings from this group excluded for the purposes of the present study
§Studies report on the same sample
ǁAlthough this study included respondents from Canada, the majority of respondents (98%) were from the US