Testing for hereditary cancer predisposition: the impact of the number of options and a provider recommendation on decision-making outcomes
Barr, Marci Lynn
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Objective: To examine how the presentation of a decision can influence choices about genetic testing for inherited cancer predispositions. Specifically, how the number of options and the addition of a personalized recommendation might influence outcomes such as the likelihood of undergoing genetic testing, the genetic test chosen, and whether a person’s test choice matches their personal preferences. Methods: An online hypothetical vignette study was completed by 454 healthy volunteers. Each participant was randomized to receive one of two survey versions which differed in the manner of presenting testing options and how these options were integrated with a provider recommendation. Regression analyses were performed to determine the relationships between the presentation of choice and participant decisions. Wilcoxon rank-sign tests were used to determine the impact of a provider recommendation on final genetic testing choices. Results: Participants were more likely to choose to undergo genetic testing when presented with three options instead of two (OR: 2.00 p=0.014). This effect was no longer observed when individuals who had decided not to undergo testing were presented with a third option (OR: 0.90 p=0.775). The addition of a provider recommendation did not significantly change the overall distribution of options chosen (p=0.746). However, after a recommendation, participants were more likely to choose the test that best matched with personal preferences about the type of genetic information desired (p<0.001). Conclusions: Participants are more likely to undergo genetic testing when presented with more options. They are also more likely to select an option in line with a personal preference if presented with a recommendation based on this preference.