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Author: Christine Krekel Publisher: ISBN: Category : Languages : en Pages : 52
Book Description
PURPOSE: To compare physician referral practices and attitudes for hereditary breast cancer between clinical practice locations: urban, suburban, and rural. METHODS: 214 physicians in Southwest Ohio's Tristate Region completed a self-administered questionnaire to assess referral practices and attitudes for hereditary breast cancer. Respondents were randomly sampled and grouped retrospectively into clinical practice location groups based on self-reported descriptor of practice location: suburban (39%), rural (32%), and urban (17%). Physician medical specialties included family practice, general practice, general surgery, internal medicine, obstetrics/gynecology, and oncology. RESULTS: Rural-practice physicians were less likely to have ever referred for hereditary breast cancer than suburban-practice physicians. Rural practice physicians were more likely to refer to an oncologist for this indication, whereas urban-practice physicians were more likely to refer to a genetic counselor. Rural practice physicians reported stronger barriers to referral, including distance to services and lack of awareness of services. Of all physicians who reported never referring, 61% reported having no need for such services, irrespective of clinical practice location. CONCLUSIONS: Women residing in rural areas are less likely to be referred for genetic services regarding hereditary breast cancer than their suburban counterparts. The reduced referral frequency among rural-practice physicians is partly due to increased barriers to referral. A significant proportion of physicians, regardless of practice location, may not recognize the benefit of genetic counseling and testing for hereditary breast cancer. Further studies are needed to investigate factors that influence physician referral for this indication, and that may vary by clinical practice location, including specialty, physician knowledge, and patient interest, and to assess the perceived value of genetic services among all physicians.
Author: Christine Krekel Publisher: ISBN: Category : Languages : en Pages : 52
Book Description
PURPOSE: To compare physician referral practices and attitudes for hereditary breast cancer between clinical practice locations: urban, suburban, and rural. METHODS: 214 physicians in Southwest Ohio's Tristate Region completed a self-administered questionnaire to assess referral practices and attitudes for hereditary breast cancer. Respondents were randomly sampled and grouped retrospectively into clinical practice location groups based on self-reported descriptor of practice location: suburban (39%), rural (32%), and urban (17%). Physician medical specialties included family practice, general practice, general surgery, internal medicine, obstetrics/gynecology, and oncology. RESULTS: Rural-practice physicians were less likely to have ever referred for hereditary breast cancer than suburban-practice physicians. Rural practice physicians were more likely to refer to an oncologist for this indication, whereas urban-practice physicians were more likely to refer to a genetic counselor. Rural practice physicians reported stronger barriers to referral, including distance to services and lack of awareness of services. Of all physicians who reported never referring, 61% reported having no need for such services, irrespective of clinical practice location. CONCLUSIONS: Women residing in rural areas are less likely to be referred for genetic services regarding hereditary breast cancer than their suburban counterparts. The reduced referral frequency among rural-practice physicians is partly due to increased barriers to referral. A significant proportion of physicians, regardless of practice location, may not recognize the benefit of genetic counseling and testing for hereditary breast cancer. Further studies are needed to investigate factors that influence physician referral for this indication, and that may vary by clinical practice location, including specialty, physician knowledge, and patient interest, and to assess the perceived value of genetic services among all physicians.
Author: Sarah Lewandowski Publisher: ISBN: Category : Languages : en Pages : 63
Book Description
Across the United States nationally recommended strategies for identifying asymptomatic individuals with predispositions to hereditary cancer syndromes are severely underutilized. The long term doctor-patient relationship between primary care providers (PCPs) and their patients makes them uniquely positioned to carry out such testing, but historically PCPs report being unknowledgeable about these topics. This study aims to 1) describe how much confidence PCPs have conducting clinical cancer consultations, 2) identify PCPs' current practices for obtaining their patients' personal and familial cancer histories, and to 3) understand how PCPs use their patients' personal and familial histories of cancer to inform their ordering of genetic testing. An online survey was distributed and follow up semi-structured interviews were conducted among a group of PCPs located throughout Washington, Wyoming, and Montana. Binary logistic regression analyses were used to explore the relationship between background variables and the PCPs' confidence scores. Interview transcripts were analyzed via a directed content analysis approach. The regression analyses showed that PCPs who practiced in more urban rural urban continuum codes (RUCC) and scored higher on the Consolidated Framework for Implementation Research (CFIR) self-efficacy subscale were more likely to have higher confidence levels with respect to initiating the conversation about cancer risk and responding to their patients' questions about cancer risk based on their family history, as well as their confidence in explaining lifetime and age-related cancer risk to their patients. The interview results revealed that most PCPs gather personal and familial cancer history from their patients via a general direct questioning process with the patient in tandem with another method. Most PCPs believe that collecting this information is important primarily because it informs their future cancer screening recommendation. Most PCPs are not ordering cancer risk genetic testing and those that are report they are really only comfortable ordering rather limited range of cancer genetic tests. Conclusions: These results suggest that PCPs recognize the benefits these early identification strategies can provide, but they don’t feel comfortable carrying out the ordering and interpretation of cancer risk genetic testing themselves. On this basis, better educational strategies, alongside implementation of updated procedures and automated prompts in electronic medical records are needed to further aid PCPs in successfully implementing universal screening and testing for predispositions to hereditary cancers in primary care settings.
Author: Publisher: ISBN: Category : Languages : en Pages : 13
Book Description
This study was designed to demonstrate the utility of brief quantitative risk assessment in breast care clinical settings as a method of referral to cancer risk counseling. We examined factors that influence the decision to undergo cancer risk counseling after the referral is made. We developed a computerized program, BRISK, that calculates interval breast cancer risks using the Gail and Claus epidemiological models, and BRCA1 and BRCA2 mutation probabilities using the Couch, Shattuck-Eidens, Frank, and BRCAPRO models. Questionnaires assessing psychological status, and knowledge and attitudes about breast cancer, cancer risk counseling, and genetic testing were used to identify predictors of referral uptake. Of the 120 subjects in the biopsy setting, 53% had breast cancer risk >- twice the population risk as measured by the epidemiological models. Of the 91 women in the treatment selling, 47% had a BRCA mutation risk >- 10%. Uptake of referral was low in the biopsy group (1/63), but higher in the treatment group (13/43). Predictors of uptake included family history of cancer, interest in family risks, high income, psychological disturbance, and perceived risk. Barriers included lack of time, cost, and fear of insurance discrimination. However, 81% thought brief risk assessment should be routine, suggesting annual mammography or OB/GYN visits as the most effective selling. Brief breast cancer risk assessment is easily incorporated into clinical settings and is well-accepted by most patients. It can be utilized not only for management of individuals, but also for public health intervention, resource allocation, and targeted research.
Author: National Academies of Sciences, Engineering, and Medicine Publisher: National Academies Press ISBN: 0309388570 Category : Social Science Languages : en Pages : 525
Book Description
Decades of research have demonstrated that the parent-child dyad and the environment of the familyâ€"which includes all primary caregiversâ€"are at the foundation of children's well- being and healthy development. From birth, children are learning and rely on parents and the other caregivers in their lives to protect and care for them. The impact of parents may never be greater than during the earliest years of life, when a child's brain is rapidly developing and when nearly all of her or his experiences are created and shaped by parents and the family environment. Parents help children build and refine their knowledge and skills, charting a trajectory for their health and well-being during childhood and beyond. The experience of parenting also impacts parents themselves. For instance, parenting can enrich and give focus to parents' lives; generate stress or calm; and create any number of emotions, including feelings of happiness, sadness, fulfillment, and anger. Parenting of young children today takes place in the context of significant ongoing developments. These include: a rapidly growing body of science on early childhood, increases in funding for programs and services for families, changing demographics of the U.S. population, and greater diversity of family structure. Additionally, parenting is increasingly being shaped by technology and increased access to information about parenting. Parenting Matters identifies parenting knowledge, attitudes, and practices associated with positive developmental outcomes in children ages 0-8; universal/preventive and targeted strategies used in a variety of settings that have been effective with parents of young children and that support the identified knowledge, attitudes, and practices; and barriers to and facilitators for parents' use of practices that lead to healthy child outcomes as well as their participation in effective programs and services. This report makes recommendations directed at an array of stakeholders, for promoting the wide-scale adoption of effective programs and services for parents and on areas that warrant further research to inform policy and practice. It is meant to serve as a roadmap for the future of parenting policy, research, and practice in the United States.
Author: National Research Council Publisher: National Academies Press ISBN: 0309170133 Category : Medical Languages : en Pages : 564
Book Description
Cancer ranks second only to heart disease as a leading cause of death in the United States, making it a tremendous burden in years of life lost, patient suffering, and economic costs. Fulfilling the Potential for Cancer Prevention and Early Detection reviews the proof that we can dramatically reduce cancer rates. The National Cancer Policy Board, part of the Institute of Medicine, outlines a national strategy to realize the promise of cancer prevention and early detection, including specific and wide-ranging recommendations. Offering a wealth of information and directly addressing major controversies, the book includes: A detailed look at how significantly cancer could be reduced through lifestyle changes, evaluating approaches used to alter eating, smoking, and exercise habits. An analysis of the intuitive notion that screening for cancer leads to improved health outcomes, including a discussion of screening methods, potential risks, and current recommendations. An examination of cancer prevention and control opportunities in primary health care delivery settings, including a review of interventions aimed at improving provider performance. Reviews of professional education and training programs, research trends and opportunities, and federal programs that support cancer prevention and early detection. This in-depth volume will be of interest to policy analysts, cancer and public health specialists, health care administrators and providers, researchers, insurers, medical journalists, and patient advocates.
Author: Institute of Medicine Publisher: National Academies Press ISBN: 0309047986 Category : Medical Languages : en Pages : 353
Book Description
Raising hopes for disease treatment and prevention, but also the specter of discrimination and "designer genes," genetic testing is potentially one of the most socially explosive developments of our time. This book presents a current assessment of this rapidly evolving field, offering principles for actions and research and recommendations on key issues in genetic testing and screening. Advantages of early genetic knowledge are balanced with issues associated with such knowledge: availability of treatment, privacy and discrimination, personal decision-making, public health objectives, cost, and more. Among the important issues covered: Quality control in genetic testing. Appropriate roles for public agencies, private health practitioners, and laboratories. Value-neutral education and counseling for persons considering testing. Use of test results in insurance, employment, and other settings.
Author: Beth N. Peshkin Publisher: IOS Press ISBN: 9781586037932 Category : Breast Languages : en Pages : 160
Book Description
A testament to how far the field of genetic counseling for breast cancer susceptibility has advanced since the mid-1990s, following the cloning of two major breast (and ovarian) cancer susceptibility genes, BRCA1 and BRCA2.
Author: Institute of Medicine Publisher: National Academies Press ISBN: 0309109973 Category : Medical Languages : en Pages : 134
Book Description
These proceedings of a workshop presented to the Institute of Medicine's (IOM) National Cancer Policy Forum on March 30, 2007, are the result of forum discussions about genetic testing and counseling at its meetings on June 16 and October 30, 2006. Those discussions, led by forum members Betty Ferrell and Patricia Ganz, noted that genetic testing and counseling are becoming more complex and important for informing patients and families of risks and benefits of certain courses of action, and yet organized expert programs are in short supply. The subject matter involves not only the scientific and clinical aspects but also workforce and reimbursement issues, among others. Drs. Ferrell and Ganz proposed that the forum could provide a useful review of the various important implications of these issues by holding and reporting a workshop on the subject. They volunteered to work with staff to organize and lead such a workshop. The agenda for the workshop is reproduced in the appendix to these proceedings. It includes the presentations of the invited speakers and the comments of speakers, forum members, and others in attendance as transcribed and edited to eliminate redundancies, grammatical errors, and otherwise make them more readable. Cancer-Related Genetic Testing and Counseling : Workshop Proceedings summarizes the workshop.
Author: William D. Foulkes Publisher: Cambridge University Press ISBN: 9780521563406 Category : Medical Languages : en Pages : 480
Book Description
Many cancers, both common and rare, are known to have a hereditary predisposition and advances in genetics have clarified the risks and in some cases the mechanisms of cancer developing in an individual. First published in 1998, this important contribution to the literature of cancer genetics covers all the key issues, reviewing both the technology behind genetic risk assessment and the ethical dilemmas it poses. It is divided into two parts. The first deals with ethical, legal and social issues. The second systematically outlines current knowledge of the inheritance patterns of many different cancer types, both from a site-by-site perspective and for special groups. This authoritative volume will be of interest to oncologists, physicians and surgeons in other specialities and to health professionals in the areas of primary care, counselling and cancer risk assessment.
Author: Christine Krekel
Author: Christine Krekel
Author: 
Author: Sarah Lewandowski
Author: 
Author: National Academies of Sciences, Engineering, and Medicine
Author: National Research Council
Author: Institute of Medicine
Author: Beth N. Peshkin
Author: Institute of Medicine
Author: William D. Foulkes