1
|
Dusic EJ, Theoryn T, Wang C, Swisher EM, Bowen DJ. Barriers, interventions, and recommendations: Improving the genetic testing landscape. Front Digit Health 2022; 4:961128. [PMID: 36386046 PMCID: PMC9665160 DOI: 10.3389/fdgth.2022.961128] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 09/27/2022] [Indexed: 11/06/2022] Open
Abstract
Individual, provider, clinic, and societal level barriers have been shown to undermine the potential impact of genetic testing. The current approach in the primary care setting places an exorbitant burden on both providers and patients. Current literature provides insight into how to address barriers across multiple levels (patient, provider, clinic, system) and at multiple stages in the testing process (identification, referral, counseling, and testing) but interventions have had limited success. After outlining the current approach to genetic testing in the primary care setting, including the barriers that prevent genetic testing uptake and the methods proposed to address these issues, we recommend integrating genetic testing into routine medical care through population-based testing. Success in efforts to increase the uptake of genetic testing will not occur without significant changes to the way genetic services are delivered. These changes will not be instantaneous but are critical in moving this field forward to realize the potential for cancer risk genetic assessment to reduce cancer burden.
Collapse
Affiliation(s)
- E. J. Dusic
- Institute of Public Health Genetics, Department of Biostatistics, University of Washington, Seattle, WA, United States
- Correspondence: E. J. Dusic
| | - Tesla Theoryn
- Institute of Public Health Genetics, Department of Biostatistics, University of Washington, Seattle, WA, United States
| | - Catharine Wang
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, United States
| | - Elizabeth M. Swisher
- Department of Obstetrics and Gynecology, Fred Hutchinson Cancer Center, University of Washington, Seattle, WA, United States
| | - Deborah J. Bowen
- Institute of Public Health Genetics, Department of Biostatistics, University of Washington, Seattle, WA, United States
- Department of Bioethics, University of Washington, Seattle, WA, United States
| | - EDGE Study Team
- Beth Devine, Department of Pharmacy, University of Washington, Seattle, WA, United States
- Barbara Norquist, Department of Obstetrics & Gynecology, University of Washington Medical Center, University of Washington, Seattle, WA, United States
- Brian Shirts, Department of Laboratory Medicine & Pathology, University of Washington Medical Center, University of Washington, Seattle, WA, United States
- Mariebeth Velasquez, Department of Family Medicine, University of Washington Medical Center, University of Washington, Seattle, WA, United States
- Michael Raff, Genomics Institute, MultiCare Health System, Tacoma, WA, United States
- Jeannine M. Brant, Clinical Science & Innovation, Billings Clinic, Billings, MT, United States
| |
Collapse
|
2
|
Dusic EJ, Bowen DJ, Bennett R, Cain KC, Theoryn T, Velasquez M, Swisher E, Brant JM, Shirts B, Wang C. Socioeconomic Status and Interest in Genetic Testing in a US-Based Sample. Healthcare (Basel) 2022; 10:880. [PMID: 35628017 PMCID: PMC9141316 DOI: 10.3390/healthcare10050880] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/02/2022] [Accepted: 05/07/2022] [Indexed: 02/01/2023] Open
Abstract
Cancer is a significant burden, particularly to individuals of low socioeconomic status (SES). Genetic testing can provide information about an individual's risk of developing cancer and guide future screening and preventative services. However, there are significant financial barriers, particularly for individuals of low SES. This study used the Early Detection of Genetic Risk (EDGE) Study's patient baseline survey (n = 2329) to evaluate the relationship between socioeconomic status and interest in pursuing hereditary cancer genetic testing. Analysis was completed for two interest outcomes-overall interest in genetic testing and interest in genetic testing if the test were free or low cost. Many demographic and SES variables were predictors for interest in genetic testing, including education, income, and MacArthur Subjective Social Scale (SSS). After controlling for the healthcare system, age, and gender, having a higher education level and a higher household income were associated with greater general interest. Lower SSS was associated with greater interest in genetic testing if the test was free or low cost. If genetic testing is the future of preventative medicine, more work needs to be performed to make this option accessible to low-SES groups and to ensure that those services are used by the most underserved populations.
Collapse
Affiliation(s)
- EJ Dusic
- Institute of Public Health Genetics, University of Washington, Seattle, WA 98105, USA;
| | - Deborah J. Bowen
- Department of Bioethics, University of Washington, Seattle, WA 98105, USA;
| | - Robin Bennett
- Genetic Counseling Graduate Program, University of Washington, Seattle, WA 98105, USA;
| | - Kevin C. Cain
- Department of Biostatistics, University of Washington, Seattle, WA 98105, USA;
| | - Tesla Theoryn
- Institute of Public Health Genetics, University of Washington, Seattle, WA 98105, USA;
| | - Mariebeth Velasquez
- University of Washington Medical Center, University of Washington Seattle, WA 98195, USA; (M.V.); (E.S.); (B.S.)
| | - Elizabeth Swisher
- University of Washington Medical Center, University of Washington Seattle, WA 98195, USA; (M.V.); (E.S.); (B.S.)
| | - Jeannine M. Brant
- Clinical Science & Innovation, Billings Clinic, Billings, MT 59105, USA;
| | - Brian Shirts
- University of Washington Medical Center, University of Washington Seattle, WA 98195, USA; (M.V.); (E.S.); (B.S.)
| | - Catharine Wang
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA 02118, USA;
| |
Collapse
|