title: Assessing controversial direct-to-consumer advertising for hereditary breast cancer testing: reactions from women and their physicians in a managed care organization.
abstract: OBJECTIVE
  To describe the impact on patients and physicians at a managed care organization (MCO) of a direct-to-consumer advertising (DTC-ad) campaign concerning testing for the BRCA1 and BRCA2 genes.
  
  
  METHODS
  Observational study.
  
  
  METHODS
  In 2003, we mailed a 30-item questionnaire to 750 randomly chosen female members of Kaiser Permanente Colorado (KPCO) aged 25 to 54 years, and 100 female KPCO members with a history of breast cancer genetic referral. We mailed a 7-item questionnaire to 180 randomly chosen KPCO primary care providers.
  
  
  RESULTS
  Of 394 patient respondents, 245 (62%) reported exposure to the DTC-ad of whom 63% reported that the DTC-ad caused no anxiety at all. A high level of perceived breast cancer risk and being of Hispanic ethnicity each were independently associated with reported anxiety due to the DTC-ad (adjusted odds ratio [OR] = 3.23, 95% confidence interval [CI] = 1.35, 7.73, and adjusted OR = 4.19, 95% CI = 1.48, 11.83, respectively). Greater knowledge was seen among respondents exposed to the DTC-ad than among those reporting no exposure (P = .015). Of the physician respondents, 84% reported that the DTC-ad caused no strain on the doctor-patient relationship, and nearly 80% reported no effect on daily clinical practice. Genetic referrals soared more than 200% compared with the prior year, when there was no advertising.
  
  
  CONCLUSIONS
  The DTC-ad had a marked impact on genetic services, but little apparent negative impact on patients or primary care providers at an MCO.
authors.affiliation: Clinical Research Unit, Kaiser Permanente Colorado, 580 Mohawk Drive, Boulder, CO 80303, USA. judy.mouchawar@kp.org
authors.forename: Judy
authors.initials: J
authors.lastname: Mouchawar
authors.forename: Suzanne
authors.initials: S
authors.lastname: Laurion
authors.forename: Debra P
authors.initials: DP
authors.lastname: Ritzwoller
authors.forename: Jennifer
authors.initials: J
authors.lastname: Ellis
authors.forename: Alanna
authors.initials: A
authors.lastname: Kulchak-Rahm
authors.forename: Sharon
authors.initials: S
authors.lastname: Hensley-Alford
mesh_terms: D000328:Adult; D000329:Advertising; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000235:genetics; D003120:Colorado; D005260:Female; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D020022:Genetic Predisposition to Disease; D005820:Genetic Testing; D006801:Humans; D008329:Managed Care Programs; D008875:Middle Aged; D010820:Physicians / Q000523:psychology*; D011795:Surveys and Questionnaires