Mikat-Stevens Natalie A, Larson Ingrid A, Tarini Beth A
American Academy of Pediatrics, Elk Grove Village, Illinois, USA.
Division of General Pediatrics, The Children's Mercy Hospitals and Clinics, Kansas City, Missouri, USA.
Genet Med. 2015 Mar;17(3):169-76. doi: 10.1038/gim.2014.101. Epub 2014 Sep 11.
We aimed to systematically review the literature to identify primary-care providers' perceived barriers against provision of genetics services.
We systematically searched PubMed and ERIC using key and Boolean term combinations for articles published from 2001 to 2012 that met inclusion/exclusion criteria. Specific barriers were identified and aggregated into categories based on topic similarity. These categories were then grouped into themes.
Of the 4,174 citations identified by the search, 38 publications met inclusion criteria. There were 311 unique barriers that were classified into 38 categories across 4 themes: knowledge and skills; ethical, legal, and social implications; health-care systems; and scientific evidence. Barriers most frequently mentioned by primary-care providers included a lack of knowledge about genetics and genetic risk assessment, concern for patient anxiety, a lack of access to genetics, and a lack of time.
Although studies reported that primary-care providers perceive genetics as being important, barriers to the integration of genetics medicine into routine patient care were identified. The promotion of practical guidelines, point-of-care risk assessment tools, tailored educational tools, and other systems-level strategies will assist primary-care providers in providing genetics services for their patients.
我们旨在系统回顾文献,以确定初级保健提供者在提供遗传学服务方面所感知到的障碍。
我们使用关键词和布尔逻辑词组合,在PubMed和教育资源信息中心(ERIC)系统检索2001年至2012年发表的符合纳入/排除标准的文章。根据主题相似性确定具体障碍并汇总分类。然后将这些类别归纳为主题。
在检索到的4174条文献中,38篇出版物符合纳入标准。共有311个独特障碍,分为4个主题下的38类:知识与技能;伦理、法律和社会影响;医疗保健系统;以及科学证据。初级保健提供者最常提到的障碍包括缺乏遗传学和遗传风险评估知识、担心患者焦虑、难以获得遗传学服务以及时间不足。
尽管研究报告称初级保健提供者认为遗传学很重要,但仍发现了将遗传学医学纳入常规患者护理的障碍。推广实用指南、即时护理风险评估工具、量身定制的教育工具以及其他系统层面的策略,将有助于初级保健提供者为患者提供遗传学服务。