Challenges and Opportunities in Engaging Primary Care Providers in BRCA Testing: Results from the BFOR Study

Area of Science:

• Genetics and Genomics
• Preventive Medicine
• Primary Care Practice

Background:

• Engaging primary care providers (PCPs) is crucial for expanding access to BRCA1/2 testing and results disclosure.
• The BRCA Founder OutReach (BFOR) study aimed to integrate PCPs into the process of disclosing BRCA1/2 founder mutation screening results.

Purpose of the Study:

• To evaluate PCP perspectives, knowledge, and experiences regarding BRCA1/2 results disclosure within the BFOR study.
• To assess the proportion of PCPs who agreed to disclose BRCA1/2 testing results to their patients.

Main Methods:

• A prospective study involving BRCA1/2 founder mutation screening in individuals of Ashkenazi Jewish descent.
• Quantitative surveys administered to 501 nominated PCPs to assess willingness, knowledge, and qualifications for results disclosure.
• Qualitative semi-structured interviews with 10 PCPs and post-disclosure surveys with 101 PCPs to explore experiences.

Main Results:

• Only 40.5% of PCPs agreed to disclose their patient's BRCA1/2 results; responders were more likely to agree (57.3%) than non-responders (28.6%).
• Insufficient knowledge was the primary reason PCPs declined disclosure; feeling qualified was significantly associated with agreement to disclose (OR 6.53).
• PCPs reported positive disclosure experiences and valued educational materials but desired better workflow integration and decision support.

Conclusions:

• Barriers to integrating BRCA1/2 testing into primary care persist, with a majority of PCPs declining to disclose results.
• PCP motivation and positive experiences suggest potential for increased engagement with appropriate support.
• Enhanced PCP training and integrated decision support tools are recommended to facilitate BRCA1/2 testing and results disclosure in primary care settings.