Department of Urology, New York University, New York, New York, USA.
Department of Population Health, New York University, New York, New York, USA.
Prostate. 2021 Aug;81(11):754-764. doi: 10.1002/pros.24172. Epub 2021 May 31.
Genetic counseling and germline testing have an increasingly important role for patients with prostate cancer (PCa); however, recent data suggests they are underutilized. Our objective was to perform a qualitative study of the barriers and facilitators of germline genetic evaluation among physicians who manage PCa.
We conducted semi-structured interviews with medical oncologists, radiation oncologists, and urologists from different U.S. practice settings until thematic saturation was achieved at n = 14. The interview guide was based on the Tailored Implementation in Chronic Diseases Framework to identify key determinants of practice. Interview transcripts were independently coded by ≥2 investigators using a constant comparative method.
The decision to perform or refer for germline genetic evaluation is affected by factors at multiple levels. Although patient factors sometimes play a role, the dominant themes in the decision to conduct germline genetic evaluation were at the physician and organizational level. Physician knowledge, coordination of care, perceptions of the guidelines, and concerns about cost were most frequently discussed as the main factors affecting utilization of germline genetic evaluation.
There are currently numerous barriers to implementation of germline genetic evaluation for PCa. Efforts to expand physician education, to develop tools to enhance genetics in practice, and to facilitate coordination of care surrounding genetic evaluation are important to promote guideline-concordant care.
遗传咨询和种系检测在前列腺癌（PCa）患者中发挥着越来越重要的作用；然而，最近的数据表明它们的利用率较低。我们的目的是对管理 PCa 的医生进行种系基因评估的障碍和促进因素进行定性研究。
我们对来自不同美国实践环境的肿瘤内科医生、放射肿瘤学家和泌尿科医生进行了半结构化访谈，直到 n=14 达到主题饱和。访谈指南基于慢性疾病的定制实施框架，以确定实践的关键决定因素。访谈记录由≥2 名研究人员使用恒定性比较方法独立编码。
进行或推荐种系基因评估的决定受到多个层面因素的影响。尽管患者因素有时会起作用，但进行种系基因评估决策的主要主题是医生和组织层面。医生的知识、护理协调、对指南的看法以及对成本的担忧是讨论最多的影响种系基因评估利用率的主要因素。
目前，实施前列腺癌种系基因评估存在许多障碍。努力扩大医生的教育，开发增强实践中遗传学的工具，以及促进遗传评估周围的护理协调，对于促进符合指南的护理至关重要。
