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Randomized Controlled Trial
. 2015 Mar;30(3):334-41.
doi: 10.1007/s11606-014-3113-5. Epub 2014 Dec 2.

Impact of a randomized controlled educational trial to improve physician practice behaviors around screening for inherited breast cancer

Robert A Bell  1 , Haley McDermott, Tonya L Fancher, Michael J Green, Frank C Day, Michael S Wilkes
Affiliations
Randomized Controlled Trial

Impact of a randomized controlled educational trial to improve physician practice behaviors around screening for inherited breast cancer

Robert A Bell et al. J Gen Intern Med. 2015 Mar.

Abstract

Background: Many primary care physicians (PCPs) are ill-equipped to provide screening and counseling for inherited breast cancer.

Objective: To evaluate the outcomes of an interactive web-based genetics curriculum versus text curriculum for primary care physicians.

Design: Randomized two-group design.

Participants: 121 California and Pennsylvania community physicians.

Intervention: Web-based interactive genetics curriculum, evaluated against a control group of physicians who studied genetics review articles. After education, physicians interacted with an announced standardized patient (SP) at risk for inherited breast cancer.

Main measures: Transcripts of visit discussions were coded for presence or absence of 69 topics relevant to inherited breast cancer.

Key results: Across all physicians, history-taking, discussions of test result implications, and exploration of ethical and legal issues were incomplete. Approximately half of physicians offered a genetic counseling referral (54.6%), and fewer (43.8%) recommended testing. Intervention physicians were more likely than controls to explore genetic counseling benefits (78.3% versus 60.7%, P = 0.048), encourage genetic counseling before testing (38.3% versus 21.3%, P = 0.048), ask about a family history of prostate cancer (25.0% versus 6.6%, P = 0.006), and report that a positive result indicated an increased risk of prostate cancer for male relatives (20.0% versus 1.6%, P = 0.001). Intervention-group physicians were less likely than controls to ask about Ashkenazi heritage (13.3% versus 34.4%, P = 0.01) or to reply that they would get tested when asked, "What would you do?" (33.3% versus 54.1%, P = 0.03).

Conclusions: Physicians infrequently performed key counseling behaviors, and this was true regardless of whether they had completed the web-based interactive training or read clinical reviews.

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Figures

Fig. 1
Fig. 1
Study flow diagram.
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References

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Supplementary concepts