title: Primary care providers' experiences with and perceptions of personalized genomic medicine.
abstract: OBJECTIVE
  To assess primary care providers' (PCPs') experiences with, perceptions of, and desired role in personalized medicine, with a focus on cancer.
  
  
  METHODS
  Qualitative study involving focus groups.
  
  
  METHODS
  Urban and rural interprofessional primary care team practices in Alberta and Ontario.
  
  
  METHODS
  Fifty-one PCPs.
  
  
  METHODS
  Semistructured focus groups were conducted and audiorecorded. Recordings were transcribed and analyzed using techniques informed by grounded theory including coding, interpretations of patterns in the data, and constant comparison.
  
  
  RESULTS
  Five focus groups with the 51 participants were conducted; 2 took place in Alberta and 3 in Ontario. Primary care providers described limited experience with personalized medicine, citing breast cancer and prenatal care as main areas of involvement. They expressed concern over their lack of knowledge, in some circumstances relying on personal experiences to inform their attitudes and practice. Participants anticipated an inevitable role in personalized medicine primarily because patients seek and trust their advice; however, there was underlying concern about the magnitude of information and pace of discovery in this area, particularly in direct-to-consumer personal genomic testing. Increased knowledge, closer ties to genetics specialists, and relevant, reliable personalized medicine resources accessible at the point of care were reported as important for successful implementation of personalized medicine.
  
  
  CONCLUSIONS
  Primary care providers are prepared to discuss personalized medicine, but they require better resources. Models of care that support a more meaningful relationship between PCPs and genetics specialists should be pursued. Continuing education strategies need to address knowledge gaps including direct-to-consumer genetic testing, a relatively new area provoking PCP concern. Primary care providers should be mindful of using personal experiences to guide care.
authors.affiliation: Family physician in the Granovsky Gluskin Family Medicine Centre at Sinai Health System in Toronto, Ont, and Clinician Scientist and Professor in the Department of Family and Community Medicine at the University of Toronto. june.carroll@sinaihealthsystem.ca.
authors.forename: June C
authors.initials: JC
authors.lastname: Carroll
authors.affiliation: Qualitative research assistant in the Departments of Family and Community Medicine, Sinai Health System, and at the University of Toronto.
authors.forename: Tutsirai
authors.initials: T
authors.lastname: Makuwaza
authors.affiliation: Clinical Director of the Alberta Family Practice Research Network, Director of the Northern Alberta Primary Care Research Network, and Director of Research in the Department of Family Medicine at the University of Alberta in Edmonton.
authors.forename: Donna P
authors.initials: DP
authors.lastname: Manca
authors.affiliation: Researcher in the Department of Family Medicine at the University of Alberta.
authors.forename: Nicolette
authors.initials: N
authors.lastname: Sopcak
authors.affiliation: Research associate in the Department of Family Medicine at Mount Sinai Hospital, Sinai Health System.
authors.forename: Joanne A
authors.initials: JA
authors.lastname: Permaul
authors.affiliation: Assistant Professor in the Department of Family and Community Medicine at the University of Toronto and Scientific Associate with the Knowledge Translation Research Network, Health Services Research Program, Ontario Institutefor Cancer Research.
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: O'Brien
authors.affiliation: Chief of the Department of Family and Community Medicine at Women's College Hospital in Toronto, a GP-oncologist at Princess Margaret Hospital in Toronto, and Clinician Investigator and Associate Professor in the Department of Family and Community Medicine at the University of Toronto.
authors.forename: Ruth
authors.initials: R
authors.lastname: Heisey
authors.affiliation: Head of the Department of Oncology at Queen's University in Kingston, Ont, Research Lead for the Canadian Partnership Against Cancer, and Co-Chair of the Canadian Cancer Research Alliance.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Eisenhauer
authors.affiliation: Research coordinator at the Dalhousie Family Medicine Teaching Unit in Fredericton, NB.
authors.forename: Julie
authors.initials: J
authors.lastname: Easley
authors.affiliation: Medical oncologist at Princess Margaret Cancer Centre in Toronto and Provincial Clinical Lead for Quality Care and Access within the Systemic Treatment Program at Cancer Care Ontario.
authors.forename: Monika K
authors.initials: MK
authors.lastname: Krzyzanowska
authors.affiliation: Professor and Director of Research at the Dalhousie Family Medicine Teaching Unit.
authors.forename: Baukje
authors.initials: B
authors.lastname: Miedema
authors.affiliation: Consultant in the Division of General Internal Medicine and Breast Diagnostic Clinic in the Department of Internal Medicine at the Mayo Clinic in Rochester, Minn.
authors.forename: Sandhya
authors.initials: S
authors.lastname: Pruthi
authors.affiliation: Medical oncologist and Adjunct Clinical Professor in the Department of Medicine at the University of Toronto and Adjunct Professor at the Institute of Health Policy, Management and Evaluation at the University of Toronto.
authors.forename: Carol
authors.initials: C
authors.lastname: Sawka
authors.affiliation: Recently retired from a senior position with the Government of Alberta.
authors.forename: Nancy
authors.initials: N
authors.lastname: Schneider
authors.affiliation: Radiation oncologist and Clinician Scientist in the Department of Oncology at McMaster University in Hamilton, Ont, and Chair of the Survivorship Advisory Committee at Cancer Care Ontario.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Sussman
authors.affiliation: Assistant Professor in the Department of Surgery, with a cross-appointment in the Department of Community Health and Epidemiology, at Dalhousie University in Halifax, NS, and is Senior Scientist at the Beatrice Hunter Cancer Research Institute in Halifax.
authors.forename: Robin
authors.initials: R
authors.lastname: Urquhart
authors.affiliation: Senior health care management consultant in Edmonton.
authors.forename: Catarina
authors.initials: C
authors.lastname: Versaevel
authors.affiliation: Giblon Professor and Vice-Chair of Research in the Department of Family and Community Medicine at the University of Toronto and Director of Knowledge Translation Research in the Health Services Research Program at the Ontario Institute for Cancer Research.
authors.forename: Eva
authors.initials: E
authors.lastname: Grunfeld
mesh_terms: D000328:Adult; D000368:Aged; D000416:Alberta; D001291:Attitude of Health Personnel; D000067108:Direct-To-Consumer Screening and Testing; D005260:Female; D017144:Focus Groups; D023281:Genomics; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy / Q000235:genetics*; D009864:Ontario; D057285:Precision Medicine / Q000523:psychology*; D036301:Qualitative Research; D013038:Specialization; D055815:Young Adult