title: Primary care providers' cancer genetic testing-related knowledge, attitudes, and communication behaviors: A systematic review and research agenda.
abstract: BACKGROUND
  Primary care providers (PCPs) can play a critical role in helping patients receive the preventive health benefits of cancer genetic risk information. Thus, the objective of this systematic review was to identify studies of US PCPs' knowledge, attitudes, and communication-related behaviors regarding genetic tests that could inform risk-stratification approaches for breast, colorectal, and prostate cancer screening in order to describe current findings and research gaps.
  
  
  METHODS
  We conducted a systematic search of six electronic databases to identify peer-reviewed empirical articles relating to US PCPs and genetic testing for breast, colorectal, or prostate cancer published in English from 2008 to 2016. We reviewed these data and used narrative synthesis methods to integrate findings into a descriptive summary and identify research needs.
  
  
  RESULTS
  We identified 27 relevant articles. Most focused on genetic testing for breast cancer (23/27) and colorectal cancer risk (12/27); only one study examined testing for prostate cancer risk. Most articles addressed descriptive research questions (24/27). Many studies (24/27) documented PCPs' knowledge, often concluding that providers' knowledge was incomplete. Studies commonly (11/27) examined PCPs' attitudes. Across studies, PCPs expressed some concerns about ethical, legal, and social implications of testing. Attitudes about the utility of clinical genetic testing, including for targeted cancer screening, were generally favorable; PCPs were more skeptical of direct-to-consumer testing. Relatively fewer studies (9/27) examined PCPs' communication practices regarding cancer genetic testing.
  
  
  CONCLUSIONS
  This review indicates a need for investigators to move beyond descriptive research questions related to PCPs' knowledge and attitudes about cancer genetic testing. Research is needed to address important gaps regarding the development, testing, and implementation of innovative interventions and educational programs that can improve PCPs' genetic testing knowledge, assuage concerns about the appropriateness of cancer genetic testing, and promote open and effective patient-provider communication about genetic risk and genetic testing.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA. hamiltoj@mskcc.org.
authors.forename: Jada G
authors.initials: JG
authors.lastname: Hamilton
authors.affiliation: Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA.
authors.forename: Ekland
authors.initials: E
authors.lastname: Abdiwahab
authors.affiliation: Patient-Centered Outcomes Research Institute, Washington, DC, USA.
authors.forename: Heather M
authors.initials: HM
authors.lastname: Edwards
authors.affiliation: UCSF Library, University of California San Francisco, San Francisco, CA, USA.
authors.forename: Min-Lin
authors.initials: ML
authors.lastname: Fang
authors.affiliation: Torrance Health IPA, Torrance Memorial Health System, Torrance, CA, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Jdayani
authors.affiliation: Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA.
authors.forename: Erica S
authors.initials: ES
authors.lastname: Breslau
mesh_terms: D055088:Early Detection of Cancer; D005260:Female; D020022:Genetic Predisposition to Disease; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000235:genetics*; D010817:Physician-Patient Relations; D058007:Physicians, Primary Care / Q000193:education; D036301:Qualitative Research; D012306:Risk; D011795:Surveys and Questionnaires
keywords: cancer; communication; genetic testing; health beliefs; knowledge; primary care