In recognition of emerging genomic innovations and their potential for improving primary care practice, the American Academy of Family Physicians (AAFP), in collaboration with the National Human Genome Research Institute (NHGRI), is making genomic medicine the topic of their 2005 Annual Clinical Focus curriculum. The AAFP is one of the largest medical organizations with a membership that comprises a group of 56,400 active family physicians who deliver care in a broad array of practice settings in rural and urban communities around the United States, Puerto Rico, the Virgin Islands and Guam. Phase I and Phase II of this two-phase study have been completed. A web survey was completed by 1035 family physicians. Phase II of the study was completed June 2006 with a follow-up survey completed with over 300 of the physicians who agreed to be recontacted. Several manuscripts and presentations are under review based on the data generated from this project.? In one manuscript, we used structural equation modeling, and identified two pathways through which family physicians became interested in genetics education. Those who preferred an innovative approach to practice had greater comfort using standard family history assessments, which in turn increased their perceptions of the value of collecting a genomics-informed optimal family history assessment (i.e., collecting disease and cause of death for three generations of blood relatives). It was via their perception of the value of an optimal family history that family physicians became interested in genetics education. The second significant pathway indicated that the family physicians who preferred innovative approaches to practice were more likely to perceive family history assessment as clinically important and to see the relevance of genetics to clinical practice for several groupings of common diseases and in turn to perceive greater value in genetics education related to common disease. Both of these pathways of influence are amenable to interventions that could increase family physicians receptivity to genomics education. ? As part of the Phase 2 survey we included a 2x2x2 experiment to evaluate factors that influence family physicians (FPs) referral decisions for BRCA 1/2 testing for a hypothetical patient, named Terry. Although Terry was not appropriate for referral to genetic counseling or testing related to BRCA 1/2, 92% of FPs reported they would refer her to genetic testing or counseling. Results indicated that FPs referral decisions were not associated with Terrys level of worry (p = 0.90), insurance status (p = 0.10) or race (p = 0.66). These referral patterns raise concerns about the impact these referral patterns may have on the very limited genetic services currently available.
