Lapkus Morta, Horowitz Bruriah, Sauer Christina, Victorson David, Poli Elizabeth, Smith Thomas W, Kopkash Katherine, Yao Katharine, Pesce Catherine
Department of Surgery, Evanston Hospital, NorthShore University Health System, Evanston, IL, USA.
Pritzker School of Medicine, University of Chicago, Chicago, IL, USA.
Ann Surg Oncol. 2023 Oct;30(10):6108-6116. doi: 10.1245/s10434-023-13895-5. Epub 2023 Jul 13.
The American Society of Breast Surgeons released a consensus statement that genetic testing should be made available to all patients with a personal history of breast cancer. However, it is not clear whether physicians feel comfortable with universal genetic testing (UGT) or if they have sufficient knowledge to interpret results and manage them appropriately.
The purpose of this study was to explore breast surgeons' attitudes toward UGT.
Breast surgeons were consented and scheduled for a semi-structured virtual interview. Transcripts were uploaded into qualitative analysis software where they were exhaustively and iteratively coded. Codes were then organized into higher-order categories and themes and data saturation were assessed.
Thirty-one surgeons completed the qualitative interview. Most surgeons practiced in the academic or community setting and most practiced in the Midwest (71.0%). The majority (90.3%) reported having a structured genetics program. The majority (96.8%) referred their patients to genetics for counseling and most preferred ordering testing through a genetic services provider. Some surgeons had concerns about access to genetic services. A minority of surgeons order UGT for all newly diagnosed breast cancer patients. The majority of respondents thought that more training in genetics was needed for surgeons. Many surgeons expressed concern about the psychosocial effects of UGT on patients.
Many surgeons expressed concerns about UGT, mainly related to discomfort with their training, access to genetic services, and the psychosocial impact on their patients. Future work is needed to determine how to improve surgeon's comfort level in implementing UGT.
美国乳腺外科医师协会发布了一项共识声明，即应为所有有乳腺癌个人病史的患者提供基因检测。然而，目前尚不清楚医生是否对普遍基因检测（UGT）感到放心，或者他们是否具备足够的知识来解读检测结果并进行适当管理。
本研究的目的是探讨乳腺外科医生对UGT的态度。
征得乳腺外科医生同意后安排进行半结构化虚拟访谈。访谈记录被上传到定性分析软件中，在该软件中对记录进行详尽且反复的编码。然后将编码组织成更高层次的类别和主题，并评估数据饱和度。
31名外科医生完成了定性访谈。大多数外科医生在学术或社区环境中执业，大多数在中西部地区执业（71.0%）。大多数（90.3%）报告称拥有结构化的遗传学项目。大多数（96.8%）将患者转介给遗传学专家进行咨询，并且大多数人更倾向于通过基因服务提供商进行检测。一些外科医生对获得基因服务表示担忧。少数外科医生会为所有新诊断的乳腺癌患者进行UGT检测。大多数受访者认为外科医生需要接受更多遗传学方面的培训。许多外科医生对UGT对患者的心理社会影响表示担忧。
许多外科医生对UGT表示担忧，主要涉及对自身培训的不自信、获得基因服务的情况以及对患者的心理社会影响。未来需要开展工作来确定如何提高外科医生实施UGT时的舒适度。
