The impact of the number of tests presented and a provider recommendation on decisions about genetic testing for cancer risk

Marci L B Schwartz 1, William M P Klein 2, Lori A H Erby 3, Christy H Smith 4, Debra L Roter 5

Affiliations

PMID: 32994107
DOI: 10.1016/j.pec.2020.09.020

Abstract

Objective: To determine how the method of presenting testing options and a provider recommendation can influence a decision about genetic testing for inherited cancer predispositions.

Methods: An online hypothetical vignette study was completed by 454 healthy volunteers. Participants were randomized to receive one of two survey versions which differed by genetic testing choice presentation. One group was shown three options simultaneously (no test, 5-gene or 15-gene), and a second group received the 15-gene option after choosing between the no test and 5-gene options. A preference-based provider recommendation was also incorporated. We examined the effect of these interventions on test selection.

Results: Participants in the simultaneous group were more likely to choose a genetic test than those in the sequential group (OR: 2.35, p=0.003). This effect was no longer observed when individuals who had selected no-test in the sequential group were told about the 15-gene test (OR: 1.03 p=0.932). Incorporating a provider recommendation into the hypothetical scenario led to more preference-consistent choices (χ2 = 8.53, p < 0.0035,).

Conclusions: A larger menu of testing choices led to higher testing uptake. A preference-based clinician recommendation resulted in more preference-consistent choices.

Practice implications: The structuring of testing options and preference-sensitive recommendations appear to facilitate informed testing decisions.

Keywords: Behavioral economics; Cancer genetics; Context effect; Decision making; Genetic testing; Hereditary cancer; Moderate penetrance genes; Multi-Gene panel testing; Number of options; Provider recommendation; Values clarification.