Perceptions of patients and healthcare providers on BRCA testing in early-stage breast cancer: Qualitative research findings

Abstract

Research on motivators and barriers to genetic testing among patients with cancer has yet to evaluate the impact of targeted treatments. This study examined the perspectives of patients and healthcare providers (HCPs) on patient decision-making around genetic testing, specifically gBRCA (germline BReast CAncer gene) testing, in early-stage breast cancer (eBC). Semi-structured telephone interviews were performed in the United States with female patients diagnosed with eBC (n = 7 tested and 5 untested) in 2017 or later, and HCPs treating eBC patients, including medical oncologists (n = 12) and genetic counselors (GCs) (n = 8). Patients and HCPs were recruited via panel databases between January and February 2023. Patients, oncologists, and genetic counselors were asked about influences on BRCA testing and the selection of adjuvant genetically targeted treatment for patients with BRCA. Data were analyzed using deductive and inductive approaches using content analysis. Patients and HCPs saw having complete information about their breast cancer and treatment options as driving patients' choice to undergo genetic testing. Patients and oncologists also recognized the influence of physician recommendations to test and the importance of patients being able to share testing results with family. Reluctance to test was linked to perceived lack of benefit for the patient's family, fear of losing insurance coverage, and increasing patient worries. HCPs indicated that testing is further impeded by patients' distrust of the medical community and the limited availability of genetic counselors. Patients were interested in treatments with high efficacy that would lower the chance of cancer recurrence, including targeted therapies. In choosing both testing and treatment, patients value information that can empower them to achieve their goals of normalcy and remission. Oncologists and GCs can respect patients' values and goals by engaging them in the decisions for testing and treatment.