Journal of Clinical Oncology, Vol 16, 2868-2876, Copyright © 1998 by American Society of Clinical Oncology
Decision-making about breast cancer susceptibility testing: how similar are the attitudes of physicians, nurse practitioners, and at-risk women?
G Geller, BA Bernhardt, T Doksum, KJ Helzlsouer, P Wilcox and NA Holtzman
Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA. ggeller@welchlink.welch.jhu.edu
PURPOSE: To determine what consumers and providers would want to discuss
about breast cancer susceptibility testing (BCST) and their preferred role
in testing decisions. METHODS: We surveyed 426 at-risk women, 143 nurse
practitioners, and 296 physicians in five specialties in Maryland. RESULTS:
All groups believe it is important to discuss how the chance of breast
cancer can be reduced and what the chances are of getting breast cancer if
the test is positive. Both provider groups attributed more importance than
consumers to discussing whether cancer can occur if the test is negative.
Discussing the risk of depression and anxiety was more important to
providers than consumers. Eighty-two percent of women would want their
providers to make a recommendation about testing, but only 43% of nurse
practitioners and 68% of physicians would do so. Eighteen percent of
physicians underestimated the importance of informed consent for testing
and 34% of discussing the risk of insurance discrimination. Fewer than 6%
of women, if found to have a mutation, would be likely to undergo
prophylactic mastectomy, whereas 12% of nurse practitioners and 34% of
physicians would be likely to recommend such surgery. One third of
respondents in all three groups supported testing a 13-year old daughter of
a mutation-carrier. CONCLUSION: Physicians should place greater value on
informed consent and discussing practical aspects of testing, and
physicians and nurse practitioners should pay more attention to the
limitations of testing children, insurance discrimination, and consumers'
desire for provider recommendations. In light of the limited discordance
between nurse practitioners and consumers, nurse practitioners can play an
increasing role in education and counseling about BCST.
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