Incorporation of genetics in primary care practice. Will physicians do the counseling and will they be directive?
Incorporation of genetics in primary care practice. Will physicians do the counseling and will they be directive?
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将遗传学纳入初级保健实践。
DOI：
10.1001/archfami.2.11.1119
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发表时间：
1993
期刊：
影响因子：
--
通讯作者：
Holtzman,NA
中科院分区：
文献类型：
--
作者：
Geller,G;Tambor,ES;Chase,GA;Hofman,KJ;Faden,RR;Holtzman,NA
目的：为了确定，通过对一个场景的反应，初级保健医生如何愿意咨询一对夫妇关于囊性纤维化的产前诊断，以及他们如何指导这对夫妇是否应该进行产前诊断，以及如果胎儿受到影响，这对夫妇是否应该终止妊娠。设计：对10个具有地理代表性的州的初级保健医生、精神病医生和遗传学专业人员进行随机抽样调查。受访者：在1759名产科医生、儿科医生、内科医生、家庭医生和精神科医生中，65%（N= 1140）的人和79%（N= 280）的医学遗传学家和遗传咨询师。受访者在是否会咨询产前诊断或咨询遗传咨询师的问题上平均分配（分别为49.4%和50.6%）。那些表示愿意提供咨询的人可能对遗传学有更多的了解，对遗传学的交流更有信心，对模糊性的容忍度更高，并且更有可能自1971年以来完成了医学培训并在农村地区执业。44%的医生会对产前诊断提出意见。男性比女性更容易发表意见（P<. 005）。只有9.6%的受访者会对堕胎发表意见。这些受访者更有可能来自不太接触遗传学的专业，并重视宗教服务。初级保健医生更有可能给他们的意见，产前诊断和堕胎比geneticprofessionals.Conclusions：在一定程度上，态度反映在实践中，遗传咨询可能是更直接的初级保健医生比遗传pro-fessionals提供，除非初级保健医生的日益involvement在遗传学改变他们的态度。
Objective: To determine, by response to a scenario, how willing primary care physicians would be to counsel a couple about prenatal diagnosis of cystic fibrosis and how directive they would be about whether the couple should undergo prenatal diagnosis and whether the couple should terminate the pregnancy if the fetus is affected.Design: Survey of a random sample of primary care phy-sicians, psychiatrists, and genetics professionals in 10 geo-graphically representative states.Respondents: Sixty-five percent (N= 1140) of 1759 ob-stetricians, pediatricians, internists, family practitioners, and psychiatrists, and 79%(N= 280) of medical geneti-cists and genetic counselors.Outcomes and Results: Respondents were evenly divided on whether they would counsel about prenatal diagnosis or refer to a genetic counselor (49.4% and 50.6%, respectively). Those who indicated that they would counsel were likely to have greater knowledge about genetics, greater confidence in communicating about genetics, and higher tolerance for ambiguity and were more likely to have completed their medical training since 1971 and to practice in a rural area. Forty-four percent of physicians would give an opinion about prenatal diagnosis. Men would be more likely to give an opinion than women (P<. 005). Only 9.6% of respondents would give an opinion regarding abortion. These respondents were more likely to come from specialties with less exposure to genetics and to value at-tendance at religious services. Primary care physicians were more likely to give their opinions about prenatal diagnosis and abortion than genetics professionals.Conclusions: To the extent that attitudes are reflected in practice, genetic counseling may be more directive when provided by primary care physicians than by genetics pro-fessionals, unless primary care physicians' growing in-volvement in genetics changes their attitudes.