Introduction
Materials and methods
Study sample and procedures
Measures
Questionnaire
Topic | Subcategory | Number of items | Scoring | Alpha | Reference | Description of questions/examples |
---|---|---|---|---|---|---|
1. Sociodemographic characteristics | n/a | n/a | n/a | n/a | n/a | Age, gender, race, specialty |
2. Practice characteristics | n/a | n/a | n/a | n/a | n/a | specialty, number and type of gene tests ordered, experience with patient care |
3. Information giving | a. Topics discussed | 5 | 5-point scale: always to never | n/a | 5 self-developed statements on how often topics are discussed when providing cancer genetic counselling | e.g. ‘Benefits and limitations of close cancer surveillance’ |
b. Skills perception | 13 | 13–65 (5-point scale: strongly agree to strongly disagree). A higher total score means a more positive perception of one’s info giving skills | 0.88 | 10 items are adapted from an unpublished questionnaire used in the radiotherapy setting and 3 items are based on Keating et al. [4] | e.g. ‘I am comfortable discussing hereditary cancer issues with my patients’ | |
4. Decision-making | a. Attitude towards patient autonomy | 14 | See Table 3
| e.g. ‘If the patient does not want to receive information about risks, the healthcare provider should respect this’ | ||
b. Attitude towards responsibility | 1 | 5-point scale (strongly agree to strongly disagree) | Self-developed. This item is added to the adapted IPAS in Table 3
| ‘It is my responsibility to help a patient make a decision about genetic testing’ | ||
c. Skills perception | 6 | 5-point scale (difficult to easy) | Self-developed | Rate the difficulty of several communication tasks related to decision-making, e.g. ‘involving the patient in the decision’ | ||
5. Enabling disease and treatment related behaviors | a. Attitude towards responsibility | 2 | 5-point scale (strongly agree to strongly disagree) | Self-developed | e.g. ‘It is my responsibility to discuss preventive behaviors such as prophylactic surgeries and/or regular cancer screening’ | |
b. Attitude towards future developments | 2 | 5-point scale (strongly agree to strongly disagree) | Self-developed and one item based on Shields et al. [5] | e.g. ‘I am optimistic that genetic research will lead to significant improvements in the treatment of complex traits’ | ||
6. Managing emotions | a. Skills perception | 7 | 5-point scale (difficult to easy) | Self-developed | Rate the difficulty of several communication tasks related to managing emotions, e.g. ‘preparing the patient for negative emotions’ | |
b. Attitude | 2 | 5-point scale (strongly agree to strongly disagree) | Self-developed | e.g. ‘It is my responsibility to manage emotions that patients experience during genetic counseling’ | ||
7. Education | a. Received training | 7 | 2 Yes/No, 2 multiple-options, 2 open questions, 1 statement with 5-point scale (strongly agree to strongly disagree) | e.g. ‘Did you receive specific training about how to communicate with patients about hereditary cancer?’ | ||
b. Use of risk models | 3 | 2 Yes/No, 1 multiple-options | Questions based on remarks in Zon et al. [7] | e.g. ‘Which web-based risk assessment models do you use?’ | ||
8. Knowledge | a. General perception | 4 | 4-point scale (Very good to very poor) | Based on Klitzman et al. [10] | e.g. ‘My knowledge about hereditary cancer genetics is…’ | |
b. Confidence | 2 | 5-point scale (Strongly agree to strongly disagree) | Based on Shields et al. [5] | e.g. ‘I am confident in my ability to interpret a variant genetic test result’ | ||
c. Objective knowledge | 9 | 3-point scale (True/False/Do not know) | Several items are derived from Erblich et al. [31] and 3 items are derived from a study among FAP-patients of one of the authors (Douma) |
Data analysis
Results
Sample characteristics
Variable | N | % |
---|---|---|
Age | ||
25–34 | 2 | 5 |
35–44 | 10 | 23 |
45–54 | 12 | 27 |
55–64 | 15 | 34 |
65–74 | 4 | 9 |
75 or older | 1 | 2 |
Gender | ||
Male | 19 | 43 |
Female | 25 | 57 |
Race | ||
Caucasian/white | 43 | 98 |
Other | 1 | 2 |
Specialty | ||
Gynecology/obstetrics | 20 | 46 |
Surgical oncology | 10 | 23 |
Medical oncology | 6 | 14 |
Family medicine | 2 | 5 |
Gastroenterology | 1 | 2 |
Other | 5 | 11 |
Number of gene tests ordered for inherited cancer susceptibility in past yeara
| ||
1–10 | 7 | 16 |
11–20 | 8 | 19 |
21–30 | 8 | 19 |
31–40 | 3 | 7 |
41–50 | 2 | 5 |
51 or more | 15 | 35 |
Ordered testing forb
| ||
Breast and ovarian cancer | 42 | 100 |
Colorectal cancer | 34 | 81 |
Endometrial cancer | 25 | 60 |
Melanoma | 16 | 39 |
Pancreatic cancer | 16 | 39 |
Other | 5 | 12 |
Years of experience in patient care | ||
1–9 | 4 | 9 |
10–19 | 14 | 32 |
20–29 | 13 | 30 |
30 or more | 13 | 30 |
Information giving
Decision-making
Item (with original item numbers) | (Strongly) Agree | Neither agree or disagree | (Strongly) Disagree | |||
---|---|---|---|---|---|---|
n | % | n | % | n | % | |
Scale: Doctors knows best (α = 0.61) | ||||||
2. It is better that the healthcare provider rather than the patient decides about genetic testing | 0 | 0 | 3 | 7 | 41 | 93 |
5. During the conversation, the patient must entrust him/herself to the expertise of the healthcare provider | 24 | 55 | 13 | 30 | 7 | 16 |
9. If the healthcare provider and the patient cannot agree on whether or not to undergo genetic testing, the healthcare provider should make the final decision | 0 | 0 | 3 | 7 | 41 | 93 |
10. The patient should, without much information on the consequences, confidently undergo genetic testing | 2 | 5 | 4 | 9 | 38 | 86 |
12. The healthcare provider can presume that the patient knows the consequences of receiving a genetic test result | 1 | 2 | 6 | 14 | 37 | 84 |
Scale: Patient should decide (α = 0.45) | ||||||
6. The patient must choose between whether to undergo genetic testing or not | 39 | 89 | 1 | 2 | 4 | 9 |
11. It would be taking things too far when the healthcare provider would decide for the patient | 38 | 86 | 3 | 7 | 3 | 7 |
14. As it concerns the body and life of the patient, the patient should make decisions about genetic testing | 41 | 93 | 2 | 5 | 1 | 2 |
Scale: Right to non-participation (α = 0.42) | ||||||
4. Patients should have the right not to be involved in the decision about genetic testing | 13 | 30 | 7 | 16 | 24 | 55 |
8. Patients who become afraid when deciding about genetic testing should be left in peace by the healthcare provider | 14 | 32 | 14 | 32 | 16 | 36 |
13. If a patient chooses not to know anything about their genetic risk, the healthcare provider should respect this | 37 | 84 | 2 | 5 | 5 | 11 |
Items not included in a subscale | ||||||
1. It is my responsibility to help a patient make a decision about genetic testinga
| 30 | 68 | 7 | 16 | 7 | 16 |
3. If a healthcare provider and patient properly consult with each other, it does not matter who makes the final decision about genetic testing | 9 | 20 | 3 | 7 | 32 | 73 |
7. Before a patient consents to genetic testing she/he should receive all information on the consequences of the test result | 41 | 93 | 1 | 2 | 2 | 5 |
Enabling disease- and treatment related behavior
Managing emotions
Education
Knowledge
Statement | Participants who gave correct answer (%) |
---|---|
If a women’s BRCA1 or BRCA2 gene result shows a variant of unknown significance, other affected family members need to be tested in order to determine the meaning of the result. (false) | 41 |
If a woman’s BRCA1 or BRCA2 gene result reveals a positive test, she should be counseled to have her ovaries surgically removed after she is done having children. (true) | 96 |
If a father has a mutation in the APC gene (Familial adenomatous polyposis (FAP), his children have a 50 % chance (1 in 2) for carrying this mutation as well. (true) | 80 |
After removal of colon polyps for an FAP diagnosis regular bowel examinations are no longer necessary. (false) | 91 |
A hereditary predisposition to FAP can skip a generation. (false) | 52 |
If a person has colorectal cancer at age 49 and also has a family member with endometrial cancer diagnosed at age 60 years, genetic testing is indicated. (true) | 84 |
A person with uterine cancer at 49 years of age has an indication for genetic counseling. (true) | 57 |
A person with two melanomas has an indication for genetic counseling. (true) | 72 |
If a female is found to have a BRCA mutation and her sister’s BRCA result is negative, the sister is still at increased risk for developing ovarian cancer. (false) | 68 |