title: Health-care referrals from direct-to-consumer genetic testing.
abstract: BACKGROUND
  direct-to-consumer genetic testing (DTC-GT) provides personalized genetic risk information directly to consumers. Little is known about how and why consumers then communicate the results of this testing to health-care professionals.
  
  
  OBJECTIVE
  to query specialists in clinical genetics about their experience with individuals who consulted them after DTC-GT.
  
  
  METHODS
  invitations to participate in a questionnaire were sent to three different groups of genetic professionals, totaling 4047 invitations, asking questions about individuals who consulted them after DTC-GT. For each case reported, respondents were asked to describe how the case was referred to them, the patient's rationale for DTC-GT, and the type of DTC-GT performed. Respondents were also queried about the consequences of the consultations in terms of additional testing ordered. The costs associated with each consultation were estimated. A clinical case series was compiled based upon clinician responses.
  
  
  RESULTS
  the invitation resulted in 133 responses describing 22 cases of clinical interactions following DTC-GT. Most consultations (59.1%) were self-referred to genetics professionals, but 31.8% were physician referred. Among respondents, 52.3% deemed the DTC-GT to be "clinically useful." BRCA1/2 testing was considered clinically useful in 85.7% of cases; 35.7% of other tests were considered clinically useful. Subsequent referrals from genetics professionals to specialists and/or additional diagnostic testing were common, generating individual downstream costs estimated to range from $40 to $20,600.
  
  
  CONCLUSIONS
  this clinical case series suggests that approximately half of clinical geneticists who saw patients after DTC-GT judged that testing was clinically useful, especially the BRCA1/2 testing. Further studies are needed in larger and more diverse populations to better understand the interactions between DTC-GT and the health-care system.
authors.affiliation: Division of Genetics, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
authors.forename: Monica A
authors.initials: MA
authors.lastname: Giovanni
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Fickie
authors.forename: Lisa S
authors.initials: LS
authors.lastname: Lehmann
authors.forename: Robert C
authors.initials: RC
authors.lastname: Green
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Meckley
authors.forename: David
authors.initials: D
authors.lastname: Veenstra
authors.forename: Michael F
authors.initials: MF
authors.lastname: Murray
mesh_terms: D022126:Access to Information; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D005820:Genetic Testing / Q000191:economics*; D006801:Humans; D010865:Pilot Projects; D012017:Referral and Consultation / Q000191:economics*; D011795:Surveys and Questionnaires