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J Genet Couns. 2017 Aug;26(4):697-715. doi: 10.1007/s10897-016-0040-0. Epub 2016 Nov 8.

Why Is Cancer Genetic Counseling Underutilized by Women Identified as at Risk for Hereditary Breast Cancer? Patient Perceptions of Barriers Following a Referral Letter.

Author information

1
University of Minnesota-Fairview, Minneapolis, MN, USA.
2
Department of Genetics, Cell Biology and Development, University of Minnesota, Minneapolis, MN, USA.
3
Allina Health, Virginia Piper Cancer Institute, 800 East 28th Street, Suite 602, Minneapolis, MN, 55407, USA.
4
Allina Health, Virginia Piper Cancer Institute, 800 East 28th Street, Suite 602, Minneapolis, MN, 55407, USA. Karen.Swenson2@allina.com.
5
Division of Applied Research, Allina Health, Minneapolis, MN, USA.

Abstract

Family history information comprises an important tool in identifying and referring patients at risk for hereditary breast and ovarian cancer (HBOC) to cancer genetic counseling. Despite recommendations and support provided by numerous professional organizations, cancer genetic counseling services are underutilized by atrisk patients. This study aimed to: (1) determine the rate of genetic counseling utilization following a referral letter, (2) characterize factors (barriers and supports) which influenced uptake of services, and (3) identify potential strategies for increasing utilization. This study evaluated the uptake of cancer genetic counseling among 603 screening mammography patients identified as having an increased risk for HBOC based on National Comprehensive Cancer Network (NCCN) guidelines. At risk individuals and their primary care providers were mailed a referral letter recommending genetic counseling. Three focus groups (N = 24) were conducted to identify responses to receiving a letter recommending genetic counseling, barriers to seeking genetic counseling, and facilitating factors to utilizing these services. Participant responses were qualitatively analyzed using thematic and cross case analysis. Within one year, 50/603 (8 %) of the identified at-risk women completed a genetic counseling appointment. Participant-perceived barriers which influenced their decision not to seek genetic counseling included lack of relevance and utility, limited knowledge about genetic counseling, concerns about the genetic counseling process, and concerns about cost and insurance coverage. Participant-perceived facilitating factors which would support a decision to seek genetic counseling included greater awareness and education about genetic counseling services when receiving a referral, and improved follow up and guidance from their provider. Findings from this study support the need for patient and primary care provider education, and improved provider-patient communication to increase uptake of genetic counseling services.

KEYWORDS:

Barriers; Cancer genetic counseling; Hereditary breast and ovarian cancer; Supports; Utilization

PMID:
27826805
DOI:
10.1007/s10897-016-0040-0
[Indexed for MEDLINE]

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