title: Factors influencing and modifying the decision to pursue genetic testing for skin cancer risk.
abstract: BACKGROUND
  Across cancers, the decision to pursue genetic testing is influenced more by subjective than objective factors. However, skin cancer, which is more prevalent, visual, and multifactorial than many other malignancies, may offer different motivations for pursuing such testing.
  
  
  OBJECTIVE
  The primary objective was to determine factors influencing the decision to receive genetic testing for skin cancer risk. A secondary objective was to assess the impact of priming with health questions on the decision to receive testing.
  
  
  METHODS
  We distributed anonymous online surveys through ResearchMatch.org to assess participant health, demographics, motivations, and interest in pursuing genetic testing for skin cancer risk. Two surveys with identical questions but different question ordering were used to assess the secondary objective.
  
  
  RESULTS
  We received 3783 responses (64% response rate), and 85.8% desired testing. Subjective factors, including curiosity, perceptions of skin cancer, and anxiety, were the most statistically significant determinants of the decision to pursue testing (P < .001), followed by history of sun exposure (odds ratio 1.85, P < .01) and history of skin cancer (odds ratio 0.5, P = .01). Age and family history of skin cancer did not influence this decision. Participants increasingly chose testing if first queried about health behaviors (P < .0001).
  
  
  CONCLUSIONS
  The decision to pursue hypothetical testing may differ from in-clinic decision-making. Self-selected, online participants may differ from the general population. Surveys may be subject to response bias.
  
  
  CONCLUSIONS
  The decision to pursue genetic testing for skin cancer is primarily determined by subjective factors, such as anxiety and curiosity. Health factors, including skin cancer history, also influenced decision-making. Priming with consideration of objective health factors can increase the desire to pursue testing.
authors.affiliation: Department of Dermatology, Stanford University School of Medicine, Stanford, California.
authors.forename: Alexander L
authors.initials: AL
authors.lastname: Fogel
authors.affiliation: Department of Dermatology, Stanford University School of Medicine, Stanford, California.
authors.forename: Prajakta D
authors.initials: PD
authors.lastname: Jaju
authors.affiliation: Department of Dermatology, Stanford University School of Medicine, Stanford, California.
authors.forename: Shufeng
authors.initials: S
authors.lastname: Li
authors.affiliation: Department of Pediatrics, Division of Adolescent Medicine, Stanford University School of Medicine, Stanford, California.
authors.forename: Bonnie
authors.initials: B
authors.lastname: Halpern-Felsher
authors.affiliation: Department of Dermatology, Stanford University School of Medicine, Stanford, California.
authors.forename: Jean Y
authors.initials: JY
authors.lastname: Tang
authors.affiliation: Department of Dermatology, Stanford University School of Medicine, Stanford, California. Electronic address: ksarin@stanford.edu.
authors.forename: Kavita Y
authors.initials: KY
authors.lastname: Sarin
mesh_terms: D000328:Adult; D001007:Anxiety / Q000523:psychology; D003657:Decision Making; D005106:Exploratory Behavior; D005260:Female; D005820:Genetic Testing; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D018570:Risk Assessment; D012878:Skin Neoplasms / Q000235:genetics* / Q000523:psychology*; D013472:Sunlight; D011795:Surveys and Questionnaires
keywords: genetic testing; health behaviors; prediction; risk; skin cancer; survey