Barriers in identification and referral to genetic counseling for familial cancer risk: The perspective of genetic service providers

Sharon J. Rolnick, Alanna K. Rahm, Jody M. Jackson, Larissa Nekhlyudov, Katrina A.B. Goddard, Terry Field, Catherine McCarty, Cynthia Nakasato, Douglas Roblin, Christopher P. Anderson, Rodolfo Valdez

Research output: Contribution to journalArticlepeer-review

32 Scopus citations


The purpose of this study was to obtain genetic counselors' perspectives about the identification of appropriate patients and barriers to referral of high-risk patients for cancer genetic counseling services. Genetic service providers from eight integrated health systems were surveyed. Data analysis included descriptive statistics. Twenty-eight of 40 potential participants responded (70%). Referrals for familial cancer risk assessment overwhelmingly came from providers (89%); only 10% were self-referrals. Use of guidelines to assist providers with referral was reported by 46% of the respondents. Genetic service providers perceived patient barriers to seeking genetic counseling after referral included: risk evaluation viewed as a non-priority (72%), concerns about impact on insurability (52%), distance to appointments (48%), lack of insurance (44%), lack of patient/provider knowledge about the value of genetic counseling (36%), discouragement by family members (28%), and fear (20%). The best approaches suggested by respondents to increase appropriate referrals were attending meetings and giving presentations to oncologists, surgeons, primary care and gynecologists. The genetic service providers reported several barriers to the referral and use of genetic counseling. This finding is consistent with current literature from the providers' perspective. Our survey adds the genetic service providers' perspective and identifies areas of opportunity for further research and intervention as few of the perceived barriers are being addressed through current educational efforts.

Original languageEnglish (US)
Pages (from-to)314-322
Number of pages9
JournalJournal of Genetic Counseling
Issue number3
StatePublished - Jun 2011


  • Genetic counseling
  • Genetic predisposition to disease
  • Genetic screening
  • Neoplasms
  • Referral and consultation


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