At the end of 2008, consumer genetic testing firm Navigenics offered MDVIP — a network of concierge-style physicians specializing in preventive care — free testing for those physicians and reduced prices on testing for patients. A year -later, Duke University's Susanne Haga sought to determine the uptake of this genomic risk profiling test, both by the doctors themselves and by their patients. There is little data on physician utility of genomic tests, Haga says, but many questions. "There's a lot of debate that physicians would not order these types of tests because of the limited clinical utility and demonstrated evidence to change behavior and clinical outcomes," she says. Of the 157 physicians Haga and her team queried, 42 percent ordered a test for a patient, and 30 percent did so for themselves.
The team administered a 27-question survey to MDVIP doctors, asking whether they had ordered the test for themselves or for their patients. The survey also looked into their prior use of traditional genetic tests, their training in genetics and genomics, and how they would prefer to learn more about genomic testing. As Haga's team reports in the Journal of General Internal Medicine, physicians who felt more informed about genetics and genomics — 45 percent of respondents — were more likely to order risk testing. Of those physicians who felt knowledgeable, 59 percent had ordered testing for themselves.
"Those who felt more informed were more likely to order traditional genetic tests, and those who ordered traditional genetic tests were more likely to order these new genomic risk tests," Haga says. "I think there's a pathway there connecting all three: knowledge, experience with simpler genetic tests, and these more complex, risk-based tests."
In addition, physicians who ordered a test for themselves were also more likely to order the test for their patients. "There's no better way to understand a test, to become familiar with a test, than to be reviewing your own results. ... It's a form of education, so to speak," she adds.
Formal training in genetics for physicians appears to be inadequate, as 49 percent of respondents indicated. Medical school curricula focus on traditional genetics, Haga says, and the portion of doctors who considered their training inadequate increased along with the number of years since they finished their formal training. "There is very little, if any, exposure to genomic risk assessment, the use of genomic technologies for clinical care decision making," she says. "Many physicians are probably receiving this type of education through continuing medical education ... as well as talking to laboratory representatives or learning the information at meetings. Their education — very basic genetics — is being supplemented much more with on-the-job training." In addition, the survey reported on physicians' perceived knowledge of genetic and genomic tests, rather than their assessed knowledge of them.
Even with 42 percent of physicians ordering a test for a patient, many physicians voiced concerns about genomic risk profiling. "Despite their recognized concerns about potential limited utility, they were ordering the test for a variety of reasons. One of the major reasons was because patients were interested in it," Haga says. "I don't know if that would be reflected in the general care population, but it was a significant finding for this unique patient-physician population."
Indeed, while findings from this population may not be generalizable, they do demonstrate an interest — on the parts of both physicians and patients — in genomic profiling.