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Impact of a randomized controlled educational trial to improve physician practice behaviors around screening for inherited breast cancer.
- Source :
-
Journal of general internal medicine [J Gen Intern Med] 2015 Mar; Vol. 30 (3), pp. 334-41. Date of Electronic Publication: 2014 Dec 02. - Publication Year :
- 2015
-
Abstract
- Background: Many primary care physicians (PCPs) are ill-equipped to provide screening and counseling for inherited breast cancer.<br />Objective: To evaluate the outcomes of an interactive web-based genetics curriculum versus text curriculum for primary care physicians.<br />Design: Randomized two-group design.<br />Participants: 121 California and Pennsylvania community physicians.<br />Intervention: Web-based interactive genetics curriculum, evaluated against a control group of physicians who studied genetics review articles. After education, physicians interacted with an announced standardized patient (SP) at risk for inherited breast cancer.<br />Main Measures: Transcripts of visit discussions were coded for presence or absence of 69 topics relevant to inherited breast cancer.<br />Key Results: Across all physicians, history-taking, discussions of test result implications, and exploration of ethical and legal issues were incomplete. Approximately half of physicians offered a genetic counseling referral (54.6%), and fewer (43.8%) recommended testing. Intervention physicians were more likely than controls to explore genetic counseling benefits (78.3% versus 60.7%, P = 0.048), encourage genetic counseling before testing (38.3% versus 21.3%, P = 0.048), ask about a family history of prostate cancer (25.0% versus 6.6%, P = 0.006), and report that a positive result indicated an increased risk of prostate cancer for male relatives (20.0% versus 1.6%, P = 0.001). Intervention-group physicians were less likely than controls to ask about Ashkenazi heritage (13.3% versus 34.4%, P = 0.01) or to reply that they would get tested when asked, "What would you do?" (33.3% versus 54.1%, P = 0.03).<br />Conclusions: Physicians infrequently performed key counseling behaviors, and this was true regardless of whether they had completed the web-based interactive training or read clinical reviews.
- Subjects :
- Adult
Breast Neoplasms diagnosis
Breast Neoplasms genetics
Early Detection of Cancer methods
Female
Genetic Counseling methods
Humans
Male
Middle Aged
Early Detection of Cancer standards
Physicians, Primary Care education
Physicians, Primary Care standards
Practice Patterns, Physicians' standards
Subjects
Details
- Language :
- English
- ISSN :
- 1525-1497
- Volume :
- 30
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Journal of general internal medicine
- Publication Type :
- Academic Journal
- Accession number :
- 25451990
- Full Text :
- https://doi.org/10.1007/s11606-014-3113-5