Impact of a Randomized Controlled Educational Trial to Improve Physician Practice Behaviors Around Screening for Inherited Breast Cancer

BACKGROUND: Many primary care physicians (PCPs) are ill-equipped to provide screening and counseling for inherited breast cancer. OBJECTIVE: To evaluate the outcomes of an interactive web-based genetics curriculum versus text curriculum for primary care physicians. DESIGN: Randomized two-group design. PARTICIPANTS: 121 California and Pennsylvania community physicians. INTERVENTION: Web-based interactive genetics curriculum, evaluated against a control group of physicians who studied genetics review articles. After education, physicians interacted with an announced standardized patient (SP) at risk for inherited breast cancer. MAIN MEASURES: Transcripts of visit discussions were coded for presence or absence of 69 topics relevant to inherited breast cancer. KEY RESULTS: Across all physicians, history-taking, discussions of test result implications, and exploration of ethical and legal issues were incomplete. Approximately half of physicians offered a genetic counseling referral (54.6 %), and fewer (43.8 %) recommended testing. Intervention physicians were more likely than controls to explore genetic counseling benefits (78.3 % versus 60.7 %, P = 0.048), encourage genetic counseling before testing (38.3 % versus 21.3 %, P = 0.048), ask about a family history of prostate cancer (25.0 % versus 6.6 %, P = 0.006), and report that a positive result indicated an increased risk of prostate cancer for male relatives (20.0 % versus 1.6 %, P = 0.001). Intervention-group physicians were less likely than controls to ask about Ashkenazi heritage (13.3 % versus 34.4 %, P = 0.01) or to reply that they would get tested when asked, “What would you do?” (33.3 % versus 54.1 %, P = 0.03). CONCLUSIONS: Physicians infrequently performed key counseling behaviors, and this was true regardless of whether they had completed the web-based interactive training or read clinical reviews.