Genetic tests have become widely available. We sought to understand the use of genetic tests in the practice of frontline clinicians within the United States Department of Veterans Affairs (VA).
We administered a web-based survey to clinicians at 20 VA facilities. Physicians, nurse practitioners, physician assistants, and pharmacists were eligible. We excluded genetics providers and clinicians not seeing patients. We used multiple logistic regression to evaluate the associations between clinician characteristics and experience with genetics.
The response rate was 11.3% (1207/10,680) and of these, 909 respondents were eligible. Only 20.8% of the respondents reported feeling prepared to use genetic tests and 13.0% of the respondents were currently ordering genetic tests; although, it was usually only 1 or 2 a year. Delivery of genetic tests without involving genetics providers was preferred by only 7.9% of the respondents. Characteristics positively associated with currently ordering genetic tests included practice in clinical and research settings, believing improving genetics knowledge could alter their practice, feeling prepared to use genetic tests, and referral of at least 1 patient to genetics in the past year.
Most VA clinicians don’t feel prepared to use genetic tests. Those with genetic testing experience are more likely to consult genetics providers. The demand for genetics providers should increase as frontline clinicians use genetic tests in their practice.
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U.S. Government Accountability Office. Genetic services: information on genetic counselor and medical geneticist workforces. Published July 31, 2020. Accessed April 25, 2021. https://www.gao.gov/products/gao-20-593
- The 2019 US medical genetics workforce: a focus on clinical genetics.Genet Med. 2021; 23: 1458-1464https://doi.org/10.1038/s41436-021-01162-5
- Innovations in service delivery in the age of genomics: workshop summary.in: Institute of Medicine (US) Roundtable on Translating Genomic-Based Research for Health. National Academies Press, 2009https://www.ncbi.nlm.nih.gov/books/NBK26394Date accessed: July 22, 2020
- Projecting the supply and demand for certified genetic counselors: a workforce study.J Genet Couns. 2018; 27: 16-20https://doi.org/10.1007/s10897-017-0158-8
- Genetics in health care: an overview of current and emerging models.Public Health Genomics. 2012; 15: 34-45https://doi.org/10.1159/000328846
- Current genetic service delivery models for the provision of genetic testing in Europe: a systematic review of the literature.Front Genet. 2019; 10: 552https://doi.org/10.3389/fgene.2019.00552
- Assessment of trust in physician: a systematic review of measures.PLoS One. 2014; 9e106844https://doi.org/10.1371/journal.pone.0106844
- Population whole exome screening: primary care provider attitudes about preparedness, information avoidance, and nudging.Med Clin North Am. 2019; 103: 1077-1092https://doi.org/10.1016/j.mcna.2019.08.004
- Veterans Health Administration. About VHA.https://www.va.gov/health/aboutvha.aspDate accessed: October 24, 2022
- Integrating germline genetics into precision oncology practice in the Veterans Health Administration: challenges and opportunities.Fed Pract. 2020; 37: S82-S88https://doi.org/10.12788/fp.0033
- Standardizing care coordination within the Department of Veterans Affairs.J Gen Intern Med. 2019; 34: 4-6https://doi.org/10.1007/s11606-019-04997-6
- Development of an evidence-based, theory-informed national survey of physician preparedness for genomic medicine and preferences for genomics continuing education.Front Genet. 2020; 11: 59https://doi.org/10.3389/fgene.2020.00059
- Health Services Research & Development. Corporate data warehouse.https://www.hsrd.research.va.gov/for_researchers/vinci/cdw.cfmDate accessed: March 7, 2022
- A note on robust variance estimation for cluster-correlated data.Biometrics. 2000; 56: 645-646https://doi.org/10.1111/j.0006-341x.2000.00645.x
- Regression standard errors in clustered samples.Stata Technical Bulletin. 1993; 13: 19-23
- Genetic referral patterns and responses to clinical scenarios: a survey of primary care providers and clinical geneticists.J Prim Care Community Health. 2021; 1221501327211046734https://doi.org/10.1177/21501327211046734
- Measuring physician practice, preparedness and preferences for genomic medicine: a national survey.BMJ Open. 2021; 11e044408https://doi.org/10.1136/bmjopen-2020-044408
- Optimizing drug outcomes through pharmacogenetics: a case for preemptive genotyping.Clin Pharmacol Ther. 2012; 92: 235-242https://doi.org/10.1038/clpt.2012.66
- Preemptive clinical pharmacogenetics implementation: current programs in five US medical centers.Annu Rev Pharmacol Toxicol. 2015; 55: 89-106https://doi.org/10.1146/annurev-pharmtox-010814-124835
- National oncology program office. Frequently asked questions.https://www.cancer.va.gov/CANCER/faq.aspDate accessed: March 16, 2022
- Population prevalence of familial cancer and common hereditary cancer syndromes. The 2005 California Health Interview Survey.Genet Med. 2010; 12: 726-735https://doi.org/10.1097/GIM.0b013e3181f30e9e
- Deficiency of knowledge of genetics and genetic tests among general practitioners, gynecologists, and pediatricians: a global problem.Genet Med. 2005; 7: 605-610https://doi.org/10.1097/01.gim.0000182895.28432.c7
- Concert genetics. The Current Landscape of Genetic Testing. Ma 10. 2017.https://www.concertgenetics.com/wp-content/uploads/2017/05/10_ConcertGenetics_CurrentLandscapeofGeneticTesting_2017Update.pdfDate accessed: November 26, 2021
- American Society of Clinical Oncology policy statement update: genetic and genomic testing for cancer susceptibility.J Clin Oncol. 2015; 33: 3660-3667https://doi.org/10.1200/JCO.2015.63.0996
- Mainstreaming genetics and genomics: a systematic review of the barriers and facilitators for nurses and physicians in secondary and tertiary care.Genet Med. 2020; 22: 1149-1155https://doi.org/10.1038/s41436-020-0785-6
- Clinical delivery of pharmacogenetic testing services: a proposed partnership between genetic counselors and pharmacists.Pharmacogenomics. 2013; 14: 957-968https://doi.org/10.2217/pgs.13.76
- Clinical outcomes of molecular tumor boards: a systematic review.JCO Precis Oncol. 2021; 5PO.20.00495https://doi.org/10.1200/PO.20.00495
- Molecular tumor boards in clinical practice.Trends Cancer. 2020; 6: 738-744https://doi.org/10.1016/j.trecan.2020.05.008
- Unskilled and unaware of it: how difficulties in recognizing one’s own incompetence lead to inflated self-assessments.J Pers Soc Psychol. 1999; 77: 1121-1134https://doi.org/10.1037//0022-35184.108.40.2061
- Factors influencing organizational adoption and implementation of clinical genetic services.Genet Med. 2014; 16: 238-245https://doi.org/10.1038/gim.2013.101
- Incentive and reminder strategies to improve response rate for internet-based physician surveys: a randomized experiment.J Med Internet Res. 2016; 18: e244https://doi.org/10.2196/jmir.6318
Published online: October 27, 2022
Accepted: September 22, 2022
Received in revised form: September 19, 2022
Received: April 1, 2022
Published by Elsevier Inc. on behalf of American College of Medical Genetics and Genomics.