title: Differences in BRCA counseling and testing practices based on ordering provider type.
abstract: OBJECTIVE
  The purpose of this study was to assess potential differences in genetic counseling services delivered by board-certified genetic health-care providers versus non-genetic health-care providers. We evaluated (i) patient recall and content of pretest genetic counseling for hereditary breast and ovarian cancer and (ii) whether full BRCA1 and 2 gene sequencing was performed when less expensive single-site or Ashkenazi Jewish founder mutation testing may have been sufficient.
  
  
  METHODS
  Participants completed a questionnaire and provided BRCA test reports that included testing provider and type of test. Chi-square tests and logistic regression were used for analysis.
  
  
  RESULTS
  Of 473 participants, >90% were white, female, and BRCA mutation carriers. Of the 276 (58%) with genetic health-care provider involvement, 97% recalled a pretest discussion as compared with 59% of those without genetic health-care provider involvement (P < 0.001). Among the subgroup who recalled a pretest discussion (n = 385), those with genetic health-care provider involvement indicated higher adherence to eight recognized genetic counseling elements, four of which were statistically significant. Furthermore, involvement of a genetic health-care provider halved the likelihood that comprehensive BRCA testing was ordered among the 266 for whom single-site or multisite-3 testing may have been sufficient (P = 0.02).
  
  
  CONCLUSIONS
  Our results suggest that genetic health-care provider involvement is associated with adherence to nationally recommended genetic counseling practices and could potentially reduce costs of BRCA genetic testing.
authors.affiliation: H. Lee Moffitt Cancer Center, Tampa, Florida, USA.
authors.forename: Deborah
authors.initials: D
authors.lastname: Cragun
authors.affiliation: H. Lee Moffitt Cancer Center, Tampa, Florida, USA.
authors.forename: Lucia
authors.initials: L
authors.lastname: Camperlengo
authors.affiliation: H. Lee Moffitt Cancer Center, Tampa, Florida, USA.
authors.forename: Emily
authors.initials: E
authors.lastname: Robinson
authors.affiliation: H. Lee Moffitt Cancer Center, Tampa, Florida, USA.
authors.forename: Meghan
authors.initials: M
authors.lastname: Caldwell
authors.affiliation: H. Lee Moffitt Cancer Center, Tampa, Florida, USA.
authors.forename: Jongphil
authors.initials: J
authors.lastname: Kim
authors.affiliation: H. Lee Moffitt Cancer Center, Tampa, Florida, USA.
authors.forename: Catherine
authors.initials: C
authors.lastname: Phelan
authors.affiliation: H. Lee Moffitt Cancer Center, Tampa, Florida, USA.
authors.forename: Alvaro N
authors.initials: AN
authors.lastname: Monteiro
authors.affiliation: H. Lee Moffitt Cancer Center, Tampa, Florida, USA.
authors.forename: Susan T
authors.initials: ST
authors.lastname: Vadaparampil
authors.affiliation: H. Lee Moffitt Cancer Center, Tampa, Florida, USA.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Sellers
authors.affiliation: H. Lee Moffitt Cancer Center, Tampa, Florida, USA.
authors.forename: Tuya
authors.initials: T
authors.lastname: Pal
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D005817:Genetic Counseling; D020022:Genetic Predisposition to Disease; D005820:Genetic Testing; D006282:Health Personnel / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D062486:Public Health Surveillance; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D011795:Surveys and Questionnaires