Attitudes of Rhode Island primary care physicians toward the use of genetic testing for breast cancer
David Bourget (Western Ontario)
David Chalmers (ANU, NYU)
Rafael De Clercq
Jack Alan Reynolds
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Physicians currently consider genetic testing for breast cancer, especially the BRCA1 and BRCA2 tests, as problematic, because their predictive value, efficacy, and benefit to patients benefit vary greatly. Individual physicians are pressured by mounting patients demanding access to genetic testing. On the one hand, many patients believe that they have the right to know their future medical condition and that their physician is obligated to respond to this right. On the other hand, a number of physicians hesitate to offer genetic testing to patients because of ethical questions concerning the efficacy of the genetic testing, the psychological and social impact of such testing on the patients or their families, and the desire to honor a patient's rights to make his/her own decisions. ^ Additionally, legal issues surround the patient's perception of the physician's obligation to offer genetic testing. If a physician knows that a patient has a family history of breast cancer but does not offer the genetic test, and if the patient or a family member develops the disease, the doctor could be sued for wrongful practices. In brief, fear of possible legal suits and/or fear of patient reprisal can complicate the ethical questions that physicians must consider together to order BRCA1 and BRCA2 genetic testing for the prediction of breast cancer. ^ This study examined the attitudes of Rhode Island primary care physicians about ordering genetic testing for breast cancer. It also compared these attitudes with the gender and the length of medical experience of these primary care physicians. The research studied four attitude clusters: the use of genetic testing; confidentiality and a third party's right to know an individual's genetic information; the physician's feeling of competency in understanding the technological, ethical, legal, and social implications of genetic testing for breast cancer; and finally, the attitude of physicians concerning responsibility to provide genetic counseling. ^ The results indicated that significant differences exist among physicians. Quite different attitudes were found regarding genetic testing and responsibility to counsel patients on the social, legal, and ethical ramifications of genetic testing for breast cancer. On the other hand, this study discovered no significant differences between physicians' gender or length of experience regarding patient confidentiality or adequacy of genetic technology. ^ As a result, these findings suggest a need to do further research on the differences found in this study. The question is, “Do these results reflect the attitudes of all primary care physicians or only the 162 doctors surveyed in Rhode Island?” ^
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