Breast cancer risk communication: Assessment of primary care physicians by standardized patients

Department of Bioethics and Humanities, University of Washington, Seattle, Washington 98195, USA.
Genetics in medicine: official journal of the American College of Medical Genetics (Impact Factor: 7.33). 08/2009; 11(10):735-41. DOI: 10.1097/GIM.0b013e3181b2e5eb
Source: PubMed


To assess primary care providers' communication about breast cancer risk.
We evaluated 86 primary care providers' communication of risk using unannounced standardized (simulated) patients. Physicians were randomly assigned to receive one of three cases: (1) moderate risk case (n = 25), presenting with a breast lump and mother with postmenopausal breast cancer; (2) high-risk (maternal side) case (n = 28), presenting with concern about breast cancer risk; and (3) high-risk (paternal side) case (n = 33), presenting with an unrelated problem. After the appointment, three qualitative parameters were assessed by standardized patients on a 3-point scale (3 = highest satisfaction, 1 = lowest): whether the physician took adequate time; acknowledged her concerns; and offered reassurance.
Mean satisfaction with physician communication was higher for the moderate risk case (2.92) than for the high-risk paternal case (2.25) or high-risk maternal case (2.42) (P < 0.0001). The score was not influenced by session length, medical specialty, or physician gender.
Physicians more consistently provided a moderate risk standardized patients with reassurance and support compared with the high-risk cases. Primary care physicians may be more unprepared or uneasy addressing the issues raised by more complex scenarios and may benefit from training in the assessment and communication of breast cancer risk.

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    • "Whether there is a sustainable impact on applicability of the training in practice, including timely identification of patients with a possible cancer predisposition syndrome and appropriate referral, will need further longer-term studies. Designed to fill gaps in physicians' competencies and boost their confidence in using basic clinical genetic principles and activities,26,27,28,29,30 the oncogenetics training addressed previously prioritized key features of genetic consultation skills and attitude but not basic science knowledge. "
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    ABSTRACT: Purpose: General practitioners are increasingly called upon to deliver genetic services and could play a key role in translating potentially life-saving advancements in oncogenetic technologies to patient care. If general practitioners are to make an effective contribution in this area, their genetics competencies need to be upgraded. The aim of this study was to investigate whether oncogenetics training for general practitioners improves their genetic consultation skills. Methods: In this pragmatic, blinded, randomized controlled trial, the intervention consisted of a 4-h training (December 2011 and April 2012), covering oncogenetic consultation skills (family history, familial risk assessment, and efficient referral), attitude (medical ethical issues), and clinical knowledge required in primary-care consultations. Outcomes were measured using observation checklists by unannounced standardized patients and self-reported questionnaires. Results: Of 88 randomized general practitioners who initially agreed to participate, 56 completed all measurements. Key consultation skills significantly and substantially improved; regression coefficients after intervention were equivalent to 0.34 and 0.28 at 3-month follow-up, indicating a moderate effect size. Satisfaction and perceived applicability of newly learned skills were highly scored. Conclusion: The general practitioner–specific training proved to be a feasible, satisfactory, and clinically applicable method to improve oncogenetics consultation skills and could be used as an educational framework to inform future training activities with the ultimate aim of improving medical care.
    Full-text · Article · May 2013 · Genetics in medicine: official journal of the American College of Medical Genetics
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    • "Finally, providers struggle to communicate genetic risk concepts to patients [15] [16] [17]. Patients have rated primary care providers poorly on knowledge of genetic conditions, and many providers are unsure how to convey risk information in a way that helps patients make informed screening decisions [10] [18]. "
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    Full-text · Article · Jan 2011 · Genetics in medicine: official journal of the American College of Medical Genetics
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