Effect of demographic and clinician factors on patients' likelihood of pursuing hereditary cancer genetic testing.

Abstract

e22538 Background: Hereditary cancer genetic testing (GT) is an essential tool for cancer screening and prevention. As indications for GT expand, we may consider whether patients are sufficiently informed and motivated to undergo testing. We surveyed people meeting criteria for GT to assess their likelihood to pursue GT. Methods: Individuals who met modified NCCN guidelines for GT based on self-reported personal/family cancer history were invited to participate in a clinical trial of interventions promoting uptake of GT. Participants completed a baseline survey assessing experiences and attitudes relating to GT. Respondents were asked to rate their perceived importance of GT and their readiness to receive GT (scale of 0-10). These outputs were averaged (Cronbach’s alpha = 0.841) into an index representing their likelihood of pursuing GT. Linear regression was performed to investigate the relationship between several independent variables and the likelihood of pursuing GT. Gender, age, and race were considered, as well as self-reported circumstantial factors including 1) whether the individual had previously heard of GT, 2) whether a biologic relative had previously received GT, 3) qualifying eligibility variable(s) (family vs personal history of cancer), and 4) whether the individual had received a clinical recommendation to undergo GT. Results: 312 participants completed the baseline survey. The mean age of respondents was 61.9 ± 14.47 years, 52% identified as male, and 91% were white. 53% of respondents qualified for the trial based on family history alone and 15% had a clinician recommendation for GT. Younger age was associated with higher likelihood of pursuing GT (p = 0.004) as was receiving a prior recommendation for GT from a clinician (p = 0.01). When clinician recommendation was added to the model, the R-squared value increased from 0.44 to 0.64, indicating that recommendation accounts for a large portion of variance. Gender, race, personal/family cancer history, having previously heard of GT, and a biologic relative having received GT were not statistically significant. Conclusions: Concordant with previous literature, clinician recommendation to undergo GT is a significant contributor to the likelihood of pursuing GT. Older individuals may have lower readiness for GT compared with their younger counterparts, which could have implications for clinicians’ approaches to genetic counseling. Given that indications for GT have expanded, clinicians should remain up to date with current clinical guidelines.