ELSIcon2022 • Paper • June 2, 2022
Christine Gunn, Emma Li, Gretchen Gignac, Magdalena Pankowska, Stephanie Loo, Kim Zayhowski, Catharine Wang
National Comprehensive Cancer Network Guidelines suggest most patients with prostate cancer may benefit from germline genetic testing, which can influence decisions about treatment. This study explores determinants of genetics referrals for patients receiving prostate cancer care among multi-disciplinary providers. We invited medical providers across specialties at an urban, safety-net hospital to participate in a 45-minute qualitative interview. Purposive sampling sought at least 2 providers per specialty: primary care, urology, radiation oncology, medical oncology, and genetics. Semi-structured telephone interviews were conducted using a flexible interview guide and professionally transcribed. A thematic analysis was performed using interpretive description. Seventeen providers completed interviews. Several themes highlighted determinants of provider referral for germline genetic testing. Providers decisions to refer for testing were attributed to the following: 1) knowledge of guidelines for testing; 2) ability to ascertain and identify those at-risk to refer; 3) judgments regarding of patient’s ability to pay for testing or understand testing purpose; 4) perceptions of the utility, relevance, or “actionability” of genetics results to guide clinical treatment decisions, which varied across specialties and timing of patient care. Although challenges were identified in the systematic ascertainment of family history and identification of patients at risk for referral, provider judgments regarding patients comprehension or financial circumstances influence their decisions to refer for genetic testing. Systems that routinely identify patients eligible for prostate cancer genetic evaluation offer opportunities to mitigate systemic biases and facilitate equitable access to genetic testing, particularly among vulnerable patient populations.