Camilla Zimmermann, MD
A physician’s confidence level in his genomic knowledge plays a significant role in attitudes towards genomic tests, especially in tests that look for changes in DNA that are taken from patients’ tumor samples, according to research from the Dana-Farber/Brigham and Women’s Cancer Center (DF/BWCC).
Physicians who are confident in their ability to interpret and explain the findings to patients were more likely to want to prescribe the test and consider using test results when making treatment recommendations while physicians with lower levels of genomic confidence were less likely to offer the testing, according to the research. Stacy W. Gray, MD, AM, who is the first author of the report, said 42% of responding oncologists approved of telling patients about test results even when their significance for the patient’s outlook and treatment is uncertain.
“The fact that we found so much variation in physicians’ confidence about their ability to use genetic data at a tertiary care National Cancer Institute-designated comprehensive cancer center makes us pause and wonder about how confident physicians in the community are about dealing with this,” said Gray, a thoracic cancer physician at Dana-Farber. “It begs the question at a national level, how are we going to make sure that this technology for cancer care is adequately delivered?”
The researchers report that 160 medical oncologists, surgeons and radiation oncologists participated in a study that asked participants about their current use of somatic testing (ie, testing patients’ tumors for known mutations one at a time), their attitudes about multiplex testing, and their confidence in their ability to understand and use genomic data. The survey did not include a direct test of the physicians’ knowledge. Results of the survey showed that 22% of doctors reported having ‘low confidence’ in their knowledge about genomics. When queried about their knowledge and their ability to make recommendations based on the test results, 14% said they lacked knowledge about how to explain the concepts to patients, and 26% doubted their ability to make treatment recommendations.
Physicians who participated in the survey said they ordered tumor genomic testing for an average of 24% of patients and only 18% of the participants planned to use multiplex tumor testing “infrequently.”
The authors of the study concluded that there is “little consensus” on how physicians plan to use genomics testing for personalized cancer care, and suggest the need for evidence-based guidelines to help doctors determine when testing is indicated.
The study is published in The Journal of Clinical Oncology
Despite a Low-Tier Ranking, Patients Remain Loyal to Their Personal Doc
Patients were no more likely to switch away from lower-tiered physicians than higher-tiered physicians within their health plan, especially if the physician was considered the patient’s personal doctor, according to findings of “The Impact of Tiered Physician Networks on Patient Choices,” published in Health Services Research.
In a tiered physician network, insurers sort providers into tiers based on cost and quality performance. Patients have a financial incentive— they pay lower cost-sharing—to see a provider in a higher performing tier. The insurer uses this approach in the hope that tiered networks spur quality improvement and cost control by motivating physicians to attain a higher tier ranking. But Anna D. Sinaiko, PhD, and Meredith B. Rosenthal, PhD, found that patients who already had a relationship with a physician continued seeing the physician, even if the physician was in a low-ranking tier. The tier ranking could not overcome the loyalty a patient felt towards his personal doctor.
“Choosing a provider or a health plan is complicated for patients, and there are many factors and sources of information that patients can take into account when making these decisions,” said Sinaiko. “Tiered networks can be an element of this process, so providers will want to be aware of the potential for tier-rankings to impact their patients’ choices both on their own and as part of referrals.”
Sinaiko, a research scientist in the department of Health Policy and Management at the Harvard University School of Public Health, reviewed administrative claims and enrollment data on 171,581 nonelderly beneficiaries enrolled in the Massachusetts Group Insurance Commission health plans that include a tiered physician network. The researchers were trying to determine the effect of a tiered physician network on patient health plan choice.