Purpose

Health-care practitioners’ (HCPs) preferences for returning secondary findings (SFs) will influence guideline compliance, shared decision-making, and patient health outcomes. This study aimed to estimate HCPs’ preferences and willingness to support the return (WTSR) of SFs in Canada.

Methods

A discrete choice experiment estimated HCPs’ preferences for the following attributes: disease risk, clinical utility, health consequences, prior experience, and patient preference. We analyzed responses with an error component mixed logit model and predicted WTSR using scenario analyses.

Results

Two hundred fifty participants of 583 completed the questionnaire (completion rate: 42.9%). WTSR was significantly influenced by patient preference and SF outcome characteristics. HCPs’ WTSR was 78% (95% confidence interval: 74–81%) when returning SFs with available medical treatment, high penetrance, severe health consequences, and patient’s preference for return. Genetics professionals had a higher WTSR than HCPs of other types when returning SFs with clinical utility and patient preference to know. HCPs >55 years of age were more likely to return SFs compared with younger HCPs.

Conclusion

This study identified factors that influence WTSR of SFs and indicates that HCPs make tradeoffs between patient preference and other outcome characteristics. The results can inform clinical scenarios and models aiming to understand shared decision-making, patient and family opportunity to benefit, and cost-effectiveness.

中文翻译：

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卫生保健从业者对从下一代测序中返回二次发现的偏好：离散选择实验。

目的

医疗保健从业者 (HCP) 对返回次要结果 (SF) 的偏好将影响指南依从性、共同决策制定和患者健康结果。本研究旨在估计 HCP 的偏好和支持加拿大 SF 回归 (WTSR) 的意愿。

方法

离散选择实验估计了 HCP 对以下属性的偏好：疾病风险、临床效用、健康后果、先前经验和患者偏好。我们使用误差分量混合 logit 模型分析响应，并使用情景分析预测 WTSR。

结果

583 名参与者中的 250 名参与者完成了问卷调查（完成率：42.9%）。WTSR 受患者偏好和 SF 结果特征的显着影响。当返回具有可用医疗、高外显率、严重健康后果和患者偏好返回的 SF 时，HCP 的 WTSR 为 78%（95% 置信区间：74-81%）。在返回具有临床实用性和患者偏好的 SF 时，遗传学专业人员的 WTSR 高于其他类型的 HCP。与年轻的 HCP 相比，55 岁以上的 HCP 更有可能返回 SF。

结论

本研究确定了影响 SF 的 WTSR 的因素，并表明 HCP 在患者偏好和其他结果特征之间进行权衡。结果可以为旨在了解共同决策、患者和家庭受益机会和成本效益的临床情景和模型提供信息。