Large, Prospective Analysis of the Reasons Patients Do Not Pursue BRCA Genetic Testing Following Genetic Counseling
Large, Prospective Analysis of the Reasons Patients Do Not Pursue BRCA Genetic Testing Following Genetic Counseling
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DOI：
10.1007/s10897-016-0064-5
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发表时间：
2017-08-01
影响因子：
1.9
通讯作者：
Raymond, Victoria M.
中科院分区：
文献类型：
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作者：
Hayden, Sommer;Mange, Sarah;Raymond, Victoria M.
遗传咨询 (GC) 和基因检测 (GT) 可以识别出受益于加强医疗管理的高风险个体。并非所有个体都在 GC 后接受 GT，了解其影响临床效率的原因、通过适当识别高风险个体降低 GT 成本并证明 GT 前 GC 的价值。由密歇根州卫生与公众服务部赞助的一个合作项目前瞻性地收集密歇根州提供者进行的 BRCA 相关 GC 就诊的匿名数据，包括人口统计数据、患者/家族癌症史、GT 结果以及 GT 下降的原因。 2008年至2012年，10,726名患者接受了GC治疗； 3476 人（32.4%）没有追求 GT。主要原因包括：不是最佳候选测试（28.1%）、没有临床指征（23.3%）以及保险/自付费用问题（13.6%）。患者不感兴趣是下降 17.1% 的主要原因。 13.4% 的未测试且拥有私人保险的个人未进行测试的主要原因是对保险/自付费用的担忧。在未经检测的乳腺癌和/或卵巢癌患者中，22.5% 的人报告保险/自付费用问题是未进行检测的主要原因，6.6% 的人未能满足医疗保险标准。在五年的时间里，近三分之一接受 BRCA GC 的患者没有追求 GT。几乎一半的患者没有进行 GT 治疗。保险/自付费用问题仍然是障碍。
Genetic counseling (GC) and genetic testing (GT) identifies high-risk individuals who benefit from enhanced medical management. Not all individuals undergo GT following GC and understanding the reasons why can impact clinical efficiency, reduce GT costs through appropriate identification of high-risk individuals, and demonstrate the value of pre-GT GC. A collaborative project sponsored by the Michigan Department of Health and Human Services prospectively collects anonymous data on BRCA-related GC visits performed by providers in Michigan, including demographics, patient/family cancer history, GT results, and reasons for declining GT. From 2008 to 2012, 10,726 patients underwent GC; 3476 (32.4%) did not pursue GT. Primary reasons included: not the best test candidate (28.1%), not clinically indicated (23.3%), and insurance/out of pocket cost concerns (13.6%). Patient disinterest was the primary reason for declining in 17.1%. Insurance/out of pocket cost concerns were the primary reason for not testing in 13.4% of untested individuals with private insurance. Among untested individuals with breast and/or ovarian cancer, 22.5% reported insurance/out of pocket cost concerns as the primary reason for not testing and 6.6% failed to meet Medicare criteria. In a five-year time period, nearly one-third of patients who underwent BRCA GC did not pursue GT. GT was not indicated in almost half of patients. Insurance/out of pocket cost concerns continue to be barriers.