The impact of the number of tests presented and a provider recommendation on decisions about genetic testing for cancer risk.
Marci L B Schwartz, William M P Klein, Lori A H Erby and 2 others
PMID 32994107WHAT IT FOUND
In a hypothetical genetic testing choice, showing all options at once made more people choose testing initially, but the overall final choices did not differ.
A values-based recommendation made choices match stated preferences.
Key findings
01When the sequential group saw only no testing or the 5-gene panel first, 79.4% chose testing. When the simultaneous group saw no testing, the 5-gene panel, and the 15-gene panel together, 88.7% chose testing, and this initial difference was statistically significant.
02Among sequential participants who first chose no testing, 48.9% said they would have wanted the 15-gene panel if it had been offered, and counting them as testers removed the significant difference in likelihood of testing.
03In the simultaneous group, a personalized provider recommendation did not significantly change the overall distribution of test choices, but test choices after the recommendation were significantly more likely to match the participant's stated information preference.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The decisions were hypothetical online choices, not real genetic testing in a clinic, so they may not predict what patients do when receiving results or talking with a provider. The sample came from NIH healthy volunteers, not a clinical patient population, and may differ in interest in research or healthcare technologies. Only 30.7% of invited people consented and 26.5% completed the survey in its entirety, so the sample may not represent the invited population. The study used 2014 testing scenarios and turnaround times, and panel content or processing times may have changed. Sequential participants who first declined testing but said they would want the expanded test were not given the full values clarification and recommendation intervention. The significant initial uptake difference disappeared when people who first declined but expressed interest in the expanded test were counted as testing.
Declared interests
The authors declared no conflicts of interest. The article is listed as NIH intramural research support.
The easy way to misread this
Do not read the higher initial uptake as proof that presenting more genetic testing options improves patient care. The scenario was hypothetical, and the difference was no longer significant when people who first declined but said they would have wanted the expanded test were counted as interested.