Increasing confidence and changing behaviors in primary care providers engaged in genetic counselling
Abstract Background Screening and counseling for genetic conditions is an increasingly important part of primary care practice, particularly given the paucity of genetic counselors in the United States. However, primary care physicians (PCPs) often have an inadequate understanding of evidence-based...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2017-09-01
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| Series: | BMC Medical Education |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12909-017-0982-4 |
| _version_ | 1819170639857057792 |
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| author | Michael S. Wilkes Frank C. Day Tonya L. Fancher Haley McDermott Erik Lehman Robert A. Bell Michael J. Green |
| author_facet | Michael S. Wilkes Frank C. Day Tonya L. Fancher Haley McDermott Erik Lehman Robert A. Bell Michael J. Green |
| author_sort | Michael S. Wilkes |
| collection | DOAJ |
| description | Abstract Background Screening and counseling for genetic conditions is an increasingly important part of primary care practice, particularly given the paucity of genetic counselors in the United States. However, primary care physicians (PCPs) often have an inadequate understanding of evidence-based screening; communication approaches that encourage shared decision-making; ethical, legal, and social implication (ELSI) issues related to screening for genetic mutations; and the basics of clinical genetics. This study explored whether an interactive, web-based genetics curriculum directed at PCPs in non-academic primary care settings was superior at changing practice knowledge, attitudes, and behaviors when compared to a traditional educational approach, particularly when discussing common genetic conditions. Methods One hundred twenty one PCPs in California and Pennsylvania physician practices were randomized to either an Intervention Group (IG) or Control Group (CG). IG physicians completed a 6 h interactive web-based curriculum covering communication skills, basics of genetic testing, risk assessment, ELSI issues and practice behaviors. CG physicians were provided with a traditional approach to Continuing Medical Education (CME) (clinical review articles) offering equivalent information. Results PCPs in the Intervention Group showed greater increases in knowledge compared to the Control Group. Intervention PCPs were also more satisfied with the educational materials, and more confident in their genetics knowledge and skills compared to those receiving traditional CME materials. Intervention PCPs felt that the web-based curriculum covered medical management, genetics, and ELSI issues significantly better than did the Control Group, and in comparison with traditional curricula. The Intervention Group felt the online tools offered several advantages, and engaged in better shared decision making with standardized patients, however, there was no difference in behavior change between groups with regard to increases in ELSI discussions between PCPs and patients. Conclusion While our intervention was deemed more enjoyable, demonstrated significant factual learning and retention, and increased shared decision making practices, there were few differences in behavior changes around ELSI discussions. Unfortunately, barriers to implementing behavior change in clinical genetics is not unique to our intervention. Perhaps the missing element is that busy physicians need systems-level support to engage in meaningful discussions around genetics issues. The next step in promoting active engagement between doctors and patients may be to put into place the tools needed for PCPs to easily access the materials they need at the point-of-care to engage in joint discussions around clinical genetics. |
| first_indexed | 2024-12-22T19:38:36Z |
| format | Article |
| id | doaj.art-29b3769771ba4d64b7015ec127f1b691 |
| institution | Directory Open Access Journal |
| issn | 1472-6920 |
| language | English |
| last_indexed | 2024-12-22T19:38:36Z |
| publishDate | 2017-09-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Medical Education |
| spelling | doaj.art-29b3769771ba4d64b7015ec127f1b6912022-12-21T18:14:55ZengBMCBMC Medical Education1472-69202017-09-0117111210.1186/s12909-017-0982-4Increasing confidence and changing behaviors in primary care providers engaged in genetic counsellingMichael S. Wilkes0Frank C. Day1Tonya L. Fancher2Haley McDermott3Erik Lehman4Robert A. Bell5Michael J. Green6School of Medicine, Office of the Dean, University of CaliforniaDepartment of Emergency Medicine, University of CaliforniaDepartment of Internal Medicine, Division of General Medicine, University of CaliforniaSchool of Medicine, University of CaliforniaDepartments of Humanities and Medicine, Penn State College of MedicineDepartment of Communication, Department of Public Health Sciences, University of CaliforniaDepartments of Humanities and Medicine, Penn State College of MedicineAbstract Background Screening and counseling for genetic conditions is an increasingly important part of primary care practice, particularly given the paucity of genetic counselors in the United States. However, primary care physicians (PCPs) often have an inadequate understanding of evidence-based screening; communication approaches that encourage shared decision-making; ethical, legal, and social implication (ELSI) issues related to screening for genetic mutations; and the basics of clinical genetics. This study explored whether an interactive, web-based genetics curriculum directed at PCPs in non-academic primary care settings was superior at changing practice knowledge, attitudes, and behaviors when compared to a traditional educational approach, particularly when discussing common genetic conditions. Methods One hundred twenty one PCPs in California and Pennsylvania physician practices were randomized to either an Intervention Group (IG) or Control Group (CG). IG physicians completed a 6 h interactive web-based curriculum covering communication skills, basics of genetic testing, risk assessment, ELSI issues and practice behaviors. CG physicians were provided with a traditional approach to Continuing Medical Education (CME) (clinical review articles) offering equivalent information. Results PCPs in the Intervention Group showed greater increases in knowledge compared to the Control Group. Intervention PCPs were also more satisfied with the educational materials, and more confident in their genetics knowledge and skills compared to those receiving traditional CME materials. Intervention PCPs felt that the web-based curriculum covered medical management, genetics, and ELSI issues significantly better than did the Control Group, and in comparison with traditional curricula. The Intervention Group felt the online tools offered several advantages, and engaged in better shared decision making with standardized patients, however, there was no difference in behavior change between groups with regard to increases in ELSI discussions between PCPs and patients. Conclusion While our intervention was deemed more enjoyable, demonstrated significant factual learning and retention, and increased shared decision making practices, there were few differences in behavior changes around ELSI discussions. Unfortunately, barriers to implementing behavior change in clinical genetics is not unique to our intervention. Perhaps the missing element is that busy physicians need systems-level support to engage in meaningful discussions around genetics issues. The next step in promoting active engagement between doctors and patients may be to put into place the tools needed for PCPs to easily access the materials they need at the point-of-care to engage in joint discussions around clinical genetics.http://link.springer.com/article/10.1186/s12909-017-0982-4inherited breast cancer, physician training, BRCA, genetic counseling, genetic testing, shared decision-making |
| spellingShingle | Michael S. Wilkes Frank C. Day Tonya L. Fancher Haley McDermott Erik Lehman Robert A. Bell Michael J. Green Increasing confidence and changing behaviors in primary care providers engaged in genetic counselling BMC Medical Education inherited breast cancer, physician training, BRCA, genetic counseling, genetic testing, shared decision-making |
| title | Increasing confidence and changing behaviors in primary care providers engaged in genetic counselling |
| title_full | Increasing confidence and changing behaviors in primary care providers engaged in genetic counselling |
| title_fullStr | Increasing confidence and changing behaviors in primary care providers engaged in genetic counselling |
| title_full_unstemmed | Increasing confidence and changing behaviors in primary care providers engaged in genetic counselling |
| title_short | Increasing confidence and changing behaviors in primary care providers engaged in genetic counselling |
| title_sort | increasing confidence and changing behaviors in primary care providers engaged in genetic counselling |
| topic | inherited breast cancer, physician training, BRCA, genetic counseling, genetic testing, shared decision-making |
| url | http://link.springer.com/article/10.1186/s12909-017-0982-4 |
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