title: Impact of a randomized controlled educational trial to improve physician practice behaviors around screening for inherited breast cancer.
abstract: BACKGROUND
  Many primary care physicians (PCPs) are ill-equipped to provide screening and counseling for inherited breast cancer.
  
  
  OBJECTIVE
  To evaluate the outcomes of an interactive web-based genetics curriculum versus text curriculum for primary care physicians.
  
  
  METHODS
  Randomized two-group design.
  
  
  METHODS
  121 California and Pennsylvania community physicians.
  
  
  METHODS
  Web-based interactive genetics curriculum, evaluated against a control group of physicians who studied genetics review articles. After education, physicians interacted with an announced standardized patient (SP) at risk for inherited breast cancer.
  
  
  METHODS
  Transcripts of visit discussions were coded for presence or absence of 69 topics relevant to inherited breast cancer.
  
  
  RESULTS
  Across all physicians, history-taking, discussions of test result implications, and exploration of ethical and legal issues were incomplete. Approximately half of physicians offered a genetic counseling referral (54.6%), and fewer (43.8%) recommended testing. Intervention physicians were more likely than controls to explore genetic counseling benefits (78.3% versus 60.7%, P = 0.048), encourage genetic counseling before testing (38.3% versus 21.3%, P = 0.048), ask about a family history of prostate cancer (25.0% versus 6.6%, P = 0.006), and report that a positive result indicated an increased risk of prostate cancer for male relatives (20.0% versus 1.6%, P = 0.001). Intervention-group physicians were less likely than controls to ask about Ashkenazi heritage (13.3% versus 34.4%, P = 0.01) or to reply that they would get tested when asked, "What would you do?" (33.3% versus 54.1%, P = 0.03).
  
  
  CONCLUSIONS
  Physicians infrequently performed key counseling behaviors, and this was true regardless of whether they had completed the web-based interactive training or read clinical reviews.
authors.affiliation: Department of Communication, Department of Public Health Sciences, University of California, Davis, One Shields Avenue, Davis, CA, 95616, USA, rabell@ucdavis.edu.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Bell
authors.forename: Haley
authors.initials: H
authors.lastname: McDermott
authors.forename: Tonya L
authors.initials: TL
authors.lastname: Fancher
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Green
authors.forename: Frank C
authors.initials: FC
authors.lastname: Day
authors.forename: Michael S
authors.initials: MS
authors.lastname: Wilkes
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000175:diagnosis / Q000235:genetics; D055088:Early Detection of Cancer / Q000379:methods / Q000592:standards*; D005260:Female; D005817:Genetic Counseling / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D058007:Physicians, Primary Care / Q000193:education* / Q000592:standards*; D010818:Practice Patterns, Physicians' / Q000592:standards*