Table 3.

DTC-GT ethical issues identified in the systematic review and description of ethical issues from the perspective of HCPs.

DTC-GT ethical issues identified in the systematic review	Description of ethical issues from the perspective of HCPs
Clinical utility	HCPs were concerned about the clinical relevance of DTC-GT and questioned whether the results could be used in practice, while other HCPs might use the results to help guide decision-making with their patients.
Clinical validity and reliability	HCPs questioned the accuracy and quality of DTC tests. Some studies evaluated whether HCPs felt the test results were trustworthy or reliable.
Genetic counselling or GP involvement in DTC-GT	HCPs had concerns that the consumer either had no or inadequate genetic counselling prior to and after getting these genetic tests. HCPs recommended that genetic counselling be provided before and after genetic testing with either GC or GP involvement.
Resource use and resulting downstream costs	Concerns that DTC-GT causes unnecessary healthcare expenditures like further investigations and follow-up visits and unnecessary referrals to other HCPs. Additionally, that time spent counselling patients about DTC-GT was perceived to not be a good use of resources and HCPs’ time.
Misinformation and understanding DTC-GT results	There were concerns addressed that the DTC-GT results were misinterpreted or misunderstood by both HCPs and consumers. HCPs were also concerned that consumers were being misled with the information that is given by DTC-GT companies.
DTC-GT companies’ financial gain/advertising	Connected to the previous issue, concerns were voiced about consumers being influenced and mislead by companies advertising about DTC-GT. Some HCPs felt that these companies were primarily seeking financial gain.
Option of limiting genetic testing to a clinical setting	Many CGs and GCs were sceptical as to whether certain genetic tests should be available DTC, while others thought that DTC-GT should be banned.
Psychological effects on patients, their behaviours and/or their anxieties due to DTC-GT	A few of the studies showed that many HCPs were concerned that DTC-GT results would be harmful to consumers and increase their anxieties or give them a false sense of security. However, some HCPs felt that these results could positively influence consumers’ behaviours.
DTC-GT threatening the genetic counselling profession	A minority of GCs in one study felt that DTC-GT could threaten their profession.
DTC-GT impact on the doctor–patient relationship	Some HCPs in one study felt that DTC-GT could affect the doctor–patient relationship since patients were getting genetic tests done without the involvement of their doctor.