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Barriers to translating emerging genetic research on smoking into clinical practice

Perspectives of primary care physicians

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Abstract

OBJECTIVE: Smoking remains the leading cause of preventable death nationally. Emerging research may lead to improved smoking cessation treatment options, including tailoring treatment by genotype. Our objective was to assess primary care physicians’ attitudes toward new genetic-based approaches to smoking treatment.

DESIGN AND SETTING: A 2002 national survey of primary care physicians. Respondents were randomly assigned a survey including 1 of 2 scenarios: a scenario in which a new test to tailor smoking treatment was described as a “genetic” test or one in which the new test was described as a “serum protein” test.

PARTICIPANTS: The study sample was randomly drawn from all U.S. primary care physicians in the American Medical Association Masterfile (e.g., those with a primary specialty of internal medicine, family practice, or general practice). Of 2,000 sampled physicians, 1,120 responded, yielding a response rate of 62.3%.

MEASUREMENTS AND MAIN RESULTS: Controlling for physician and practice characteristics, describing a new test as “genetic” resulted in a regression-adjusted mean adoption score of 73.5, compared to a score of 82.5 for a nongenetic test, reflecting an 11% reduction in physicians’ likelihood of offering such a test to their patients.

CONCLUSIONS: Merely describing a new test to tailor smoking treatment as “genetic” poses a significant barrier to physician adoption. Considering national estimates of those who smoke on a daily basis, this 11% reduction in adoption scores would translate into 3.9 million smokers who would not be offered a new genetic-based treatment for smoking. While emerging genetic research may lead to improved smoking treatment, the potential of novel interventions will likely go unrealized unless barriers to clinical integration are addressed.

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References

  1. Centers for Disease Control and Prevention. Cigarette smoking among adults—United States, 2000. MMWR. 2002;51:642–5.

    Google Scholar 

  2. Silagy C, Lancaster T, Stead L, Mant D, Fowler G. Nicotine replacement therapy for smoking cessation. Cochrane Database Syst Rev. 2002;3:CD000146.

  3. Hughes JR, Goldstein MG, Hurt RD, Shiffman S. Recent advances in the pharmacotherapy of smoking. JAMA. 1999;281:72–6.

    Article  PubMed  CAS  Google Scholar 

  4. Lerman C, Niaura R. Applying genetic approaches to the treatment of nicotine dependence. Oncogene. 2002;21:7412–20.

    Article  PubMed  CAS  Google Scholar 

  5. Heath AC, Martin NG. Genetic models for the natural history of smoking: evidence for a genetic influence on smoking persistence. Addict Behav. 1993;18:19–34.

    Article  PubMed  CAS  Google Scholar 

  6. Kendler KS, Neale MC, Sullivan P, Corey LA, Gardner CO, Prescott CA. A population-based twin study in women of smoking initiation and nicotine dependence. Psychol Med. 1999;29:299–308.

    Article  PubMed  CAS  Google Scholar 

  7. Sullivan PF, Kendler KS. The genetic epidemiology of smoking. Nicotine Tob Res. 1999;1(suppl 2):S51-S57.

    Article  PubMed  Google Scholar 

  8. True WR, Xian H, Scherrer JF, et al. Common genetic vulnerability for nicotine and alcohol dependence in men. Arch Gen Psychiatry. 1999;56:655–61.

    Article  PubMed  CAS  Google Scholar 

  9. Lerman C, Berrettini W. Elucidating the role of genetic factors in smoking behavior and nicotine dependence. Am J Med Genet. 2003;118B:48–54.

    Article  PubMed  Google Scholar 

  10. Xu C, Goodz S, Sellers EM, Tyndale RF. CYP2A6 genetic variation and potential consequences. Adv Drug Deliv Rev. 2002;54:1245–56.

    Article  PubMed  CAS  Google Scholar 

  11. Lerman C, Caporaso NE, Audrain J, et al. Evidence suggesting the role of specific genetic factors in cigarette smoking. Health Psychol. 1999;18:14–20.

    Article  PubMed  CAS  Google Scholar 

  12. Lerman C, Caporaso NE, Bush A, et al. Tryptophan hydroxylase gene variant and smoking behavior. Am J Med Genet. 2001;105:518–20.

    Article  PubMed  CAS  Google Scholar 

  13. Noble EP, St Jeor ST, Ritchie T, et al. D2 dopamine receptor gene and cigarette smoking: a reward gene? Med Hypotheses. 1994;42:257–60.

    Article  PubMed  CAS  Google Scholar 

  14. Sabol SZ, Nelson ML, Fisher C, et al. A genetic association for cigarette smoking behavior. Health Psychol. 1999;18:7–13.

    Article  PubMed  CAS  Google Scholar 

  15. Spitz MR, Shi H, Yang F, et al. Case-control study of the D2 dopamine receptor gene and smoking status in lung cancer patients. J Natl Cancer Inst. 1998;90:358–63.

    Article  PubMed  CAS  Google Scholar 

  16. Sullivan PF, Jiang Y, Neale MC, Kendler KS, Straub RE. Association of the tryptophan hydroxylase gene with smoking initiation but not progression to nicotine dependence. Am J Med Genet. 2001;105:479–84.

    Article  PubMed  CAS  Google Scholar 

  17. Lerman C, Shields PG, Wileyto EP, et al. Pharmacogenetic investigation of smoking cessation treatment. Pharmacogenetics. 2002;12:627–34.

    Article  PubMed  CAS  Google Scholar 

  18. Lerman C, Wileyto EP, Patterson F, et al. The functional mu opiod receptor (OPRM1) Asn40Asp variant predicts short-term response to nicotine replacement therapy in a clinical trial. Pharmacogenomics J. 2004;4:184–92.

    Article  PubMed  CAS  Google Scholar 

  19. Evans WE, Relling MV. Pharmacogenomics: translating functional genomics into rational therapeutics. Science. 1999;286:487–91.

    Article  PubMed  CAS  Google Scholar 

  20. Poolsup N, Li Wan Po A, Knight TL. Pharmacogenetics and psychopharmacotherapy. J Clin Pharm Ther. 2000;25:197–220.

    Article  PubMed  CAS  Google Scholar 

  21. Roses AD. Pharmacogenetics and the practice of medicine. Nature. 2000;405:857–65.

    Article  PubMed  CAS  Google Scholar 

  22. Contopoulos-Ioannidis DG, Ntzani E, Ioannidis JP. Translation of highly promising basic science research into clinical applications. Am J Med. 2003;114:477–84.

    Article  PubMed  Google Scholar 

  23. Crowley WF Jr. Translation of basic research into useful treatments: how often does it occur? Am J Med. 2003;114:503–5.

    Article  PubMed  Google Scholar 

  24. Shields AE, Lerman C, Sallivan PF. Translating emerging research on the genetics of smoking into clinical practice: ethical and social considerations. Nicotine Tobacco Res. 2004;6:675–88.

    Article  Google Scholar 

  25. Carey TS, Garrett J. Patterns of ordering diagnostic tests for patients with acute low back pain. The North Carolina Back Pain Project. Ann Intern Med. 1996;125:807–14.

    PubMed  CAS  Google Scholar 

  26. Mandelblatt JS, Berg CD, Meropol NJ, et al. Measuring and predicting surgeons’ practice styles for breast cancer treatment in older women. Med Care. 2001;39:228–42.

    Article  PubMed  CAS  Google Scholar 

  27. Peabody JW, Luck J, Glassman P, Dresselhaus TR, Lee M. Comparison of vignettes, standardized patients, and chart abstraction: a prospective validation study of 3 methods for measuring quality. JAMA. 2000;283:1715–22.

    Article  PubMed  CAS  Google Scholar 

  28. Church AH. Estimating the effect of incentives on mail survey response rates: a meta-analysis. Public Opin Q. 1993;57:62–79.

    Article  Google Scholar 

  29. Singer E, Groves RM, Corning AD. Differential incentives: beliefs about practices, perceptions of equity, and effects on survey participation. Public Opin Q. 1999;63:251–60.

    Article  Google Scholar 

  30. Area Resource File (ARF). February 2003. U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Health Professions, Rockville, MD. Available at: http://www.arfsys.com. Accessed January 2004.

  31. Substance Abuse and Mental Health Services Administration. Results from the 2001 National Household Survey on Drug Abuse. Volume 1: Summary of National Findings. U.S. Department of Health and Human Services, Rockville, MD; 2002.

  32. Emery J, Watson E, Rose P, Andermann A. A systematic review of the literature exploring the role of primary care in genetic services. Fam Pract. 1999;16:426–45.

    Article  PubMed  CAS  Google Scholar 

  33. Suchard MA, Yudkin P, Sinsheimer JS. Are general practitioners willing and able to provide genetic services for common diseases?. J Genet Couns. 1999;8:301–11.

    Article  Google Scholar 

  34. National Human Genome Research Institute. Search the NHGRI Policy and Legislation Database by U.S. State. Available at: http://222.genome.gov/policyEthics/LegDatabase/pubMapSearch.cfm. Accessed June 2004.

  35. Stamp MJ, David SP. Are family physicians willing to use pharmacogenetics for smoking cessation therapy? Fam Med. 2003;35:83.

    PubMed  Google Scholar 

  36. Rogers E. Diffusion of Innovations. New York, NY: Free Press of Glencoe; 1962.

    Google Scholar 

  37. Hofman KL, Tambor ES, Chase GA, Geller G, Faden RR, Holtzman NA. Physicians’ knowledge of genetics and genetic tests. Acad Med. 1993;68:625–32.

    Article  PubMed  CAS  Google Scholar 

  38. Demmer LA, O’Neill MJ, Roberts AE, Clay MC. Knowledge of ethical standards in genetic testing among medical students, residents, and practicing physicians. JAMA. 2000;284:2595–6.

    Article  PubMed  CAS  Google Scholar 

  39. Ford CA, Millstein SG. Delivery of confidentiality assurances to adolescents by primary care physicians. Arch Pediatr Adolesc Med. 1997;151:505–9.

    PubMed  CAS  Google Scholar 

  40. Hayflick SJ, Eiff MP, Carpenter L, Steinberger J. Primary care physicians’ utilization and perceptions of genetics services. Genet Med. 1998;1:13–21.

    Article  PubMed  CAS  Google Scholar 

  41. James C, Geller G, Bernhardt BA, Doksum T, Holtzman NA. Are practicing and future physicians prepared to obtain informed consent? The case of genetic testing for the susceptibility to breast cancer. Community Genet. 1998;1:203–12.

    Article  PubMed  Google Scholar 

  42. Carnes M, Howell T, Rosenberg M, Francis J, Hildebrand C, Knuppel J. Physicians vary in approches to the clinical management of delirium. J Am Geriatr Soc. 2003;51:234–9.

    Article  PubMed  Google Scholar 

  43. Haghbin Z, Streltzer J, Danko GP. Assisted suicide and AIDS patients. A survey of physician’ attitudes. Psychosomatics. 1998;39:18–23.

    PubMed  CAS  Google Scholar 

  44. Hodges MO, Tolle SW, Stocking C, Cassel CK. Tube feeding. Internists’ attitudes regarding ethical obligations. Arch Intern Med. 1994;154:1013–20.

    Article  PubMed  CAS  Google Scholar 

  45. Mallory MD, Shay DK, Garrett J, Bordley WC. Bronchiolitis management preferences and the influence of pulse oximetry and respiratory rate on the decision to admit. Pediatrics. 2003;111:e45-e51.

    Article  PubMed  Google Scholar 

  46. Menasha JD, Schechter C, Willner J. Genetic testing: a physician’s perspective. Mount Sinai J Med. 2000;67:144–51.

    CAS  Google Scholar 

  47. Slome LR, Mitchell TF, Charlebois E, Benevedes JM, Abrams DI. Physician-assisted suicide and patients with human immunodeficiency virus disease. N Engl J Med. 1997;336:417–21.

    Article  PubMed  CAS  Google Scholar 

  48. Swarztrauber K, Vickrey BG, Mittman BS. Physicians’ preferences for specialty involvement in the care of patients with neurological conditions. Med Care. 2002;40:1196–209.

    Article  PubMed  Google Scholar 

  49. Roberts JS. Anticipating response to predictive genetic testing for Alzheimer’s disease: a survey of first-degree relatives. Gerontologist. 2000;40:43–52.

    PubMed  CAS  Google Scholar 

  50. Baker TB, Hatsukami DK, Lerman C, O’Malley SS, Shields AE, Fiore MC. Transdisciplinary science applied to the evaluation of treatments for tobacco use. Nicotine Tob Res. 2003;5:S89-S99.

    Article  PubMed  Google Scholar 

  51. Clayton RR, Scutchfield FD, Wyatt SW. Hutchinson Smoking Prevention Project: a new gold standard in prevention science requires new transdisciplinary thinking. J Natl Cancer Inst. 2000;92:1964–5.

    Article  PubMed  CAS  Google Scholar 

  52. American Society of Human Genetics Social Issues Subcommittee on Familial Disclosure. ASHG statement: professional disclosure of familial genetic information. Am J Hum Genet. 1998;62:474–83.

    Article  Google Scholar 

  53. Collins FS. Preparing health professionals for the genetic revolution. JAMA. 1997;278:1285–6.

    Article  PubMed  CAS  Google Scholar 

  54. Stephenson J. As discoveries unfold, a new urgency to bring genetic literacy to physicians. JAMA. 1997;278:1225–6.

    Article  PubMed  CAS  Google Scholar 

  55. Malek JI, Geller G, Sugarman J. Talking about cases in bioethics: the effect of an intensive course on health care professionals. J Med Ethics. 2000;26:131–6.

    Article  PubMed  CAS  Google Scholar 

  56. Freedman AN, Wideroff L, Olson L, et al. US physicians’ attitudes toward genetic testing for cancer susceptibility. Am J Med Genet. 2003;120A:63–71.

    Article  PubMed  CAS  Google Scholar 

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Author information

Authors and Affiliations

  1. Health Policy Institute, Georgetown Public Policy Institute, Georgetown University, Washington, DC, USA

    Alexandra E. Shields PhD & Catherine B. Comstock MPH

  2. Institute for Health Policy, Massachusetts General Hospital/Partners HealthCare System, Boston, MA, USA

    David Blumenthal MD, MPH

  3. Departments of Medicine and Health Care Policy, Harvard Medical School, Boston, MA, USA

    David Blumenthal MD, MPH

  4. Midwest Center for Health Services and Policy Research, Hines VA Medical Center, Hines, IL, USA

    Kevin B. Weiss MD, MPH

  5. Center for Healthcare Studies and Division of General Medicine, Department of Medicine, Northwestern Feinberg School of Medicine, Chicago, IL, USA

    Kevin B. Weiss MD, MPH

  6. Survey Research Division, RTI International, Research Triangle Park, NC, USA

    Douglas Currivan PhD

  7. Department of Psychiatry, University of Pennsylvania Abramson Cancer Center, Philadelphia, PA, USA

    Caryn Lerman PhD

  8. Annenberg Public Policy Center, Philadelphia, PA, USA

    Caryn Lerman PhD

Authors
  1. Alexandra E. Shields PhD
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  2. David Blumenthal MD, MPH
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  3. Kevin B. Weiss MD, MPH
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  4. Catherine B. Comstock MPH
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  5. Douglas Currivan PhD
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  6. Caryn Lerman PhD
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Corresponding author

Correspondence to Alexandra E. Shields PhD.

Additional information

None of the authors has any conflicts of interest related to this study.

This work is supported by The Robert Wood Johnson Foundation (AES) and a Transdisciplinary Tobacco Use Research Center grant (CL), funded by the National Cancer Institute and National Institute on Drug Abuse (P50 CA/DA84718).

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Shields, A.E., Blumenthal, D., Weiss, K.B. et al. Barriers to translating emerging genetic research on smoking into clinical practice. J GEN INTERN MED 20, 131–138 (2005). https://doi.org/10.1111/j.1525-1497.2005.30429.x

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  • DOI: https://doi.org/10.1111/j.1525-1497.2005.30429.x

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