title: Universal tumor screening for Lynch syndrome: health-care providers' perspectives.
abstract: Population-based reflex testing of colorectal tumors can identify individuals with Lynch syndrome (LS), but there is debate regarding the type of patient discretion such a program warrants. We examined health-care providers' views and experiences to inform the design of a reflex-testing program and their perspectives regarding an opt-out option.
  
  
  
  We interviewed providers managing LS or colorectal cancer patients, including surgeons, genetic counselors, oncologists, primary-care physicians, and gastroenterologists. Qualitative data were analyzed thematically using constant comparison techniques.
  
  
  
  Providers supported a reflex-testing program because of the current lack of coordinated immunohistochemistry (IHC) testing and underascertainment of LS patients as well as the opportunity to standardize the increasing use of genomic tests in practice. Most supported an opt-out after reflex testing because they felt that IHC is akin to other pathology tests, which are not optional. Some favored an opt-out before testing because of concern for patients experiencing distress, insurance discrimination, or a diagnostic odyssey that may be inconclusive.
  
  
  
  Providers support a reflex-testing program to improve the identification and management of suspected LS patients. However, how to support meaningful information provision to enable an opt-out without jeopardizing testing uptake and the anticipated public health benefits remains a policy challenge.Genet Med advance online publication 06 October 2016.
authors.affiliation: Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.|Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Bombard
authors.affiliation: Independent Qualitative Researcher, Toronto, Ontario, Canada.
authors.forename: Linda
authors.initials: L
authors.lastname: Rozmovits
authors.affiliation: Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.|Department of Surgery, St. Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Anne
authors.initials: A
authors.lastname: Sorvari
authors.affiliation: Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.|Department of Surgery, St. Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Corinne
authors.identifier: 0000-0002-1210-6246
authors.initials: C
authors.lastname: Daly
authors.affiliation: Department of Family and Community Medicine, Sinai Health System, Toronto, Ontario, Canada.
authors.forename: June C
authors.identifier: 0000-0002-5893-4194
authors.initials: JC
authors.lastname: Carroll
authors.affiliation: Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.|Department of Surgery, University of Toronto, Toronto, Ontario, Canada.|Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada.|Cancer Care Ontario, Toronto, Ontario, Canada.
authors.forename: Erin
authors.initials: E
authors.lastname: Kennedy
authors.affiliation: Cancer Care Ontario, Toronto, Ontario, Canada.|Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.|Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Linda
authors.initials: L
authors.lastname: Rabeneck
authors.affiliation: Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.|Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.|Department of Surgery, St. Michael's Hospital, Toronto, Ontario, Canada.|Department of Surgery, University of Toronto, Toronto, Ontario, Canada.|Cancer Care Ontario, Toronto, Ontario, Canada.
authors.forename: Nancy N
authors.identifier: 0000-0003-4793-4620
authors.initials: NN
authors.lastname: Baxter
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D003123:Colorectal Neoplasms, Hereditary Nonpolyposis / Q000175:diagnosis* / Q000235:genetics; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D036301:Qualitative Research