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R.
Gramling, MD, Principal Investigator
Justin
Nash, Karen Siren, MPH; Larry Culpepper, MD MPH
Three
hundred members of the MAFP shared thoughts with us
on our one page survey (43% of MAFP). This is a very
respectable percentage of physician responders…we're
usually "filing" them away because of the
competing demands on our time. Thanks for your effort.
 Here
are some of the main points we learned from you. About
90 percent of you felt screening for an inherited risk
of cancer was important to your practice and nearly
half felt it was very important. However, only 9 percent
of you feel very confident in your screening ability
and over 1/3 felt unable to screen effectively. Data
coming out of Great Britain and Canada suggest both
that primary care providers there have similar perspectives
and that cancer family history screening tools can be
effective for both the recognition and initial management
of individuals with concerning family histories of cancer.
As a direct result of your input, we are working with
others to develop and test such interventions in our
healthcare system.
Some
concern exists about the possibility of inducing a fatalistic
response by testing individuals for predisposition to
cancer. Empirical data in this area is limited. No responders
to this questionnaire reported that they thought individuals
would be less likely to pursue screening for cancer
given a concerning result. Similarly, the vast majority
of responders felt that recipients of a high-risk DNA
test would improve their diet and exercise, screen for
other diseases and quit smoking. While we did not ask
about whether these expected behaviors are appropriate
or healthy responses, it appears that respondents have
a low concern of fatalism resulting from testing. It
was also very clear that those who felt that screening
was appropriate tended to endorse more optimism about
the effects of testing on behavior. Your thoughts will
help in the development of observational research to
assess these outcomes of DNA testing.
While
300 of the MAFP members responded, we do not know the
feelings of the other 400. The discussion of our results
in subsequent publications will remain humble and limited
but it will contribute to the international debate about
predictive genetics in primary care. Thanks for your
time and thoughts.
Sincerely,
Bob
Gramling, MD Corresponding author
Larry Culpepper,
MD MPH
Karen Siren, MPH
Bob Baldor, MD MPH
Joe Stone
NEWS!!!
The first MASSNET study to be published will
appear in the May/June 2003 issue of Genetics
in Medicine.
Gramling
R, Nash J, Siren K, Culpepper L. Predictive genetics
in primary care:Expectations for the motivational impact
of genetic testing affects the importance family physicians
place on screening for familial cancer risk. Genetics
in Medicine. 5:3.
Another
paper by the authors entitled "Family
physician self-efficacy with screening for an inherited
risk of cancer" will soon be published
in the Annals
of Family Medicine.
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