“I think that a brief conversation from their provider can go a very long way”: Patient and provider perspectives on barriers and facilitators of genetic testing after ovarian cancer

Adrianne R. Mallen, Claire C. Conley, Lindsay Fuzzell, Dana Ketcher, Bianca M. Augusto, McKenzie K. McIntyre, Laura V. Barton, Mary K. Townsend, Brooke L. Fridley, Shelley S. Tworoger, Robert M. Wenham, Susan T. Vadaparampil

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Objective: Identify predisposing, enabling, and reinforcing factors impacting genetic counseling/testing among ovarian cancer patients guided by Green and Kreuter’s PRECEDE-PROCEED model. Methods: Gynecologic oncology providers (N = 4), genetic counselors (N = 4), and ovarian cancer patients (N = 9) completed semi-structured qualitative interviews exploring participants’ knowledge of and experiences with genetic counseling/testing. Interviews were audio recorded, transcribed verbatim, and analyzed using inductive content analysis by two independent raters. Results: Thematic analysis identified predisposing, enabling, and reinforcing factors impacting referral for and uptake of genetic counseling/testing. Predisposing factors included participant’s knowledge, beliefs, and attitudes related to genetic counseling/testing. Both patients and providers also cited that insurance coverage and out-of-pocket cost are major concerns for ovarian cancer patients considering genetic testing. Finally, both patients and providers emphasized that genetic counseling/testing would provide additional information to an ovarian cancer patient. While providers emphasized that genetic testing results were useful for informing a patient’s personal treatment plan, patients emphasized that this knowledge would be beneficial for their family members. Conclusion: Barriers to genetic testing for ovarian cancer patients exist at multiple levels, including the patient (e.g., knowledge, attitudes), the provider (e.g., workload, availability of services), the institution (e.g., difficulty with referrals/scheduling), and the healthcare system (e.g., insurance/cost). Interventions aiming to increase genetic testing among ovarian cancer patients will likely need to target multiple levels of influence. Future quantitative studies are needed to replicate these results. This line of work will inform specific multilevel intervention strategies that are adaptable to different practice settings, ultimately improving guideline concordant care.

Original languageEnglish (US)
Pages (from-to)2663-2677
Number of pages15
JournalSupportive Care in Cancer
Issue number5
StatePublished - May 2021
Externally publishedYes

Bibliographical note

Funding Information:
This work was supported by an institutional grant through the “Miles for Moffitt” program (PIs: Vadaparampil & Wenham), a grant from the National Cancer Institute (T32CA090314, PIs: Brandon & Vadaparampil), and the Collaborative Data Services Core and the Biostatistics Core at Moffitt Cancer Center, an NCI-designated comprehensive cancer center designated and funded in part by a Cancer Center Support Grant (P30CA076292; PI: Cleveland). Availability of data and material

Publisher Copyright:
© 2020, Springer-Verlag GmbH Germany, part of Springer Nature.


  • BRCA1/2
  • Genetic counseling
  • Ovarian cancer
  • genetic testing


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