The primary care physician role in cancer genetics: a qualitative study of patient experience.
BACKGROUND
Increased availability of genetic testing is changing the primary care role in cancer genetics. The perspective of primary care physicians (PCPs) regarding their role in support of genetic testing has been explored, but little is known about the expectations of patients or the PCP role once genetic test results are received.


METHODS
Two sets of open-ended semi-structured interviews were completed with patients (N=25) in a cancer genetic programme in Ontario, Canada, within 4 months of receiving genetic test results and 1 year later; written reports of test results were collected.


RESULTS
Patients expected PCPs to play a role in referral for genetic testing; they hoped that PCPs would have sufficient knowledge to appreciate familial risk and supportive attitudes towards genetic testing. Patients had more difficulty in identifying a PCP role following receipt of genetic test results; cancer patients in particular emphasized this as a role for cancer specialists. Still, some patients anticipated an ongoing PCP role comprising risk-appropriate surveillance or reassurance, especially as specialist care diminished. These expectations were complicated by occasional confusion regarding the ongoing care appropriate to genetic test results.


CONCLUSIONS
The potential PCP role in cancer genetics is quite broad. Patients expect PCPs to play a role in risk identification and genetics referral. In addition, some patients anticipated an ongoing role for their PCPs after receiving genetic test results. Sustained efforts will be needed to support PCPs in this expansive role if best use is to be made of investments in cancer genetic services.
Department of Health Policy, Management and Evaluation, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada. fiona.miller@utoronto.ca
Fiona A
FA
Miller
June C
JC
Carroll
Brenda J
BJ
Wilson
Jessica P
JP
Bytautas
Judith
J
Allanson
Mario
M
Cappelli
Sonya
S
de Laat
Fred
F
Saibil
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003266:Continuity of Patient Care; D005260:Female; D005820:Genetic Testing; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008495:Medical Oncology; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis / Q000235:genetics*; D017060:Patient Satisfaction; D010819:Physician's Role; D058007:Physicians, Primary Care; D012017:Referral and Consultation; D055815:Young Adult