DECISION-MAKING ABOUT BREAST-CANCER SUSCEPTIBILITY TESTING - HOW SIMILAR ARE THE ATTITUDES OF PHYSICIANS, NURSE PRACTITIONERS, AND AT-RISK WOMEN

Purpose: To determine what consumers and providers would want to discu ss about breast cancer susceptibility resting (BCST) and their preferr ed role in testing decisions. Methods: We surveyed 426 at-risk women, 143 nurse practitioners, and 296 physicians in five specialties in Mar yland, Results: All groups believe it is important to discuss how the chance of breast cancer can be reduced and what the chances are of get ting breast cancer if the test is positive. Both provider groups attri buted more importance than consumers to discussing whether cancer can occur if the test is negative. Discussing the risk of depression and a nxiety was more important to providers than consumers, Eighty-two perc ent of women would want their providers to make a recommendation about testing, but only 43% of nurse practitioners and 68% of physicians wo uld do so. Eighteen percent of physicians underestimated the importanc e of informed consent for testing and 34% of discussing the risk of in surance discrimination. Fewer than 6% of women, if found to have a mut ation, would be likely to undergo prophylactic mastectomy, whereas 12% of nurse practitioners and 34% of physicians would be likely to recom mend such surgery. One third of respondents in all three groups suppor ted testing a 13-year old daughter of a mutation-carrier, Conclusion: Physicians should place greater value on informed consent and discussi ng practical aspects of testing, and physicians and nurse practitioner s should pay more attention to the limitations of testing children, in surance discrimination, and consumers' desire for provider recommendat ions. In light of the limited discordance between nurse practitioners and consumers, nurse practitioners can play an increasing role in educ ation and counseling about BCST. J Clin Oncol 16:2868-2876. (C) 1998 b y American Society of Clinical Oncology.