Graduation Date

Spring 5-5-2023

Document Type

Capstone

Degree Name

Master’s of Genetic Counseling

Department

Genetic Counseling

First Advisor

Terri Blase

Second Advisor

Jessica Maxwell

Abstract

Prior literature has described unique psychosocial considerations for emerging adults (18- to 25-year-olds) considering predictive BRCA genetic testing. Due to these unique concerns, the Society of Gynecologic Oncology (SGO) recommends waiting until individuals are older than 21 before offering testing. While primary care providers (PCPs) are important stakeholders in increasing access to hereditary cancer genetic testing, their approach for emerging adults has not been previously described. We surveyed PCPs in Nebraska regarding their pre- and post-test clinical practices as well as attitudes towards BRCA genetic testing for unaffected 19- to 24-year-olds. Pre-test clinical practice questions and attitudes questions were asked twice, once for a 19- to 21-year-old patient, and once for a 22- to 24-year-old patient to evaluate for differences in PCPs approaches based on patient age. For patients who meet national guidelines (NCCN), participants responded they are initiating conversations (93.8%), providing pre-test education and ordering testing (56.3%), and disclosing positive results (55.5%). Participants had positive attitudes towards BRCA genetic testing with a mean attitude score of 6.38, on a scale of -18 to +18. No significant difference existed between a 19- to 21-year-old patient and a 22- to 24-year-old patient for participants’ pre-test practices or attitudes. The results of this pilot study identify that PCPs in Nebraska are currently taking on an active role in BRCA genetic testing for unaffected emerging adults and that their approach to testing does not appear to be impacted by the SGO guidelines. PCPs may be giving more weight to the potential benefits of testing than the potential drawbacks which could impact how they frame the risks and benefits to patients. Future educational efforts for PCPs should incorporate guidance on providing anticipatory guidance, while continuing to minimize barriers to genetic counseling services for patients.

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