Attitudes and Practices Among Internists Concerning Genetic Testing
Attitudes and Practices Among Internists Concerning Genetic Testing
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DOI：
10.1007/s10897-012-9504-z
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发表时间：
2013-02-01
影响因子：
1.9
通讯作者：
Appelbaum, Paul S.
中科院分区：
文献类型：
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作者：
Klitzman, Robert;Chung, Wendy;Appelbaum, Paul S.
关于医生是否、何时以及如何进行基因检测，以及他们的决定涉及哪些因素，仍然存在许多问题。我们调查了来自两个学术医疗中心的220名内科医生对基因检测的利用情况。遗传利用率因疾病而异。受访者最有可能订购了莱顿因子V测试（16.8%），其次是乳腺癌/卵巢癌（15.0%）。在过去的6个月里，65%的人曾就遗传问题向患者提供咨询，44%的人曾要求进行遗传检测，38.5%的人曾将患者推荐给遗传咨询师或遗传学家，27.5%的人曾收到商业实验室的基因检测广告。只有4.5%的人曾试图隐藏或掩饰遗传信息，<2%的人曾有患者报告遗传歧视。只有53.4%的人知道遗传学家/遗传咨询师可以将患者转介给谁。大多数人认为他们对遗传学（73.7%）和基因检测指南（87.1%）的知识非常/有点差。大多数人认为需要更多的培训，包括何时订购测试（79%），以及如何咨询患者（82%），解释结果（77.3%）和维护隐私（80.6%）。如果患者询问基因检测，医生更有可能要求进行基因检测（p < .001），如果医生有一个遗传学家/遗传咨询师谁转介病人（p < .002），在过去6个月内将患者转介给遗传学家/遗传咨询师，（p < .019），对患者进行遗传学咨询，更大的实践（p < .032），更少的非洲裔美国患者（p < .027），以及报告遗传歧视的患者（p < .044）。在多元逻辑回归中，订购基因检测与询问检测的患者相关，将患者转介给遗传学家/遗传咨询师并知道如何订购检测。这些数据表明，医生认识到他们的知识缺陷，并有兴趣在培训。这些发现对未来的医学实践、研究和教育具有重要意义。
Many questions remain concerning whether, when, and how physicians order genetic tests, and what factors are involved in their decisions. We surveyed 220 internists from two academic medical centers about their utilization of genetic testing. Rates of genetic utilizations varied widely by disease. Respondents were most likely to have ordered tests for Factor V Leiden (16.8 %), followed by Breast/Ovarian Cancer (15.0 %). In the past 6 months, 65 % had counseled patients on genetic issues, 44 % had ordered genetic tests, 38.5 % had referred patients to a genetic counselor or geneticist, and 27.5 % had received ads from commercial labs for genetic testing. Only 4.5 % had tried to hide or disguise genetic information, and < 2 % have had patients report genetic discrimination. Only 53.4 % knew of a geneticist/genetic counselor to whom to refer patients. Most rated their knowledge as very/somewhat poor concerning genetics (73.7 %) and guidelines for genetic testing (87.1 %). Most felt needs for more training on when to order tests (79 %), and how to counsel patients (82 %), interpret results (77.3 %), and maintain privacy (80.6 %). Physicians were more likely to have ordered a genetic test if patients inquired about genetic testing (p < .001), and if physicians had a geneticist/genetic counselor to whom to refer patients (p < .002), had referred patients to a geneticist/genetic counselor in the past 6 months, had more comfort counseling patients about testing (p < .019), counseled patients about genetics, larger practices (p < .032), fewer African-American patients (p < .027), and patients who had reported genetic discrimination (p < .044). In a multiple logistic regression, ordering a genetic test was associated with patients inquiring about testing, having referred patients to a geneticist/genetic counselor and knowing how to order tests. These data suggest that physicians recognize their knowledge deficits, and are interested in training. These findings have important implications for future medical practice, research, and education.