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reflex testing: automatic, routine
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abstract:
Universal tumor screening for Lynch syndrome: health-care providers' perspectives
Purpose:
Population-based reflex testing of colorectal tumors can
identify individuals with Lynch syndrome (LS), but there is debate
regarding the type of patient discretion such a program warrants. We
examined health-care providers’ views and experiences to inform the
design of a reflex-testing program and their perspectives regarding an
opt-out option.
Methods:
We interviewed providers managing LS or colorectal
cancer patients, including surgeons, genetic counselors, oncologists,
primary-care physicians, and gastroenterologists. Qualitative data were
analyzed thematically using constant comparison techniques.
Results:
Providers supported a reflex-testing program because of
the current lack of coordinated immunohistochemistry (IHC) testing and
underascertainment of LS patients as well as the opportunity to
standardize the increasing use of genomic tests in practice. Most
supported an opt-out after reflex testing because they felt that IHC is
akin to other pathology tests, which are not optional. Some favored an
opt-out before testing because of concern for patients experiencing
distress, insurance discrimination, or a diagnostic odyssey that may be
inconclusive.
Conclusion:
Providers support a reflex-testing program to improve
the identification and management of suspected LS patients. However, how
to support meaningful information provision to enable an opt-out
without jeopardizing testing uptake and the anticipated public health
benefits remains a policy challenge.
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