***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Genetic testing for inherited germ-line mutations associated with cancer susceptibility is an emerging technology in medical practice . Limited information is currently available about physician use of  cancer susceptibility tests ( CSTs )  . In 1999 - 2000 , a nationally representative survey was conducted to estimate prevalence of CST use by United States physicians and assess demographic , training , practice setting , and practice patterns associated with use . A stratified r and om sample of clinicians in eight specialties was selected from a file of all licensed physicians . In total , 1251 physicians , including 820 in primary care and 431 in tertiary care , responded to a 15-min question naire by mail , telephone , fax , or Internet ( response rate = 71.0 % ) . In the previous 12 months , 31.2 % [ 95 % confidence interval ( CI ) , 28.5 - 33.9 ] overall , including 30.6 % ( 95 % CI , 27.5 - 33.7 ) in primary care and 33.4 % ( 95 % CI , 27.9 - 38.9 ) in tertiary care , had ordered CSTs or referred patients elsewhere for risk assessment or testing . More physicians referred patients elsewhere [ 26.7 % ( 95 % CI , 24.2 - 29.2 ) ] than directly ordered tests [ 7.9 % ( 95 % CI , 6.3 - 9.5 ) ] . Factors associated with ordering or referring included practice location in the Northeast [ odds ratio ( OR ) , 2.30 ; 95 % CI , 1.46 - 3.63 % ] , feeling qualified to recommend CSTs ( OR , 1.96 ; 95 % CI = 1.41 - 2.72 ) , receiving CST advertising material s ( OR , 1.97 ; 95 % CI , 1.40 - 2.78 % ) , and most notably , having patients who asked whether they can or should get tested ( OR , 5.52 ; 95 % CI , 3.97 - 7.67 % ) . Lower CST use was associated with not knowing if there were local testing and counseling facilities ( OR , 0.39 ; 95 % CI , 0.23 - 0.66 % ) . These findings underscore the importance of establishing effective clinical approaches to test use and promoting physician education to facilitate communication with patients about cancer genetics Purpose : Genetic screening can enable timely detection and treatment of hereditary hemochromatosis ( HH ) . Little is known about patient acceptability of DNA testing as compared to conventional phenotypic testing . Methods : Within the HEIRS Study , a large primary -care screening study of HH and iron overload , we r and omly assigned participants to receive brief information on either HH genotypic or phenotypic testing , and assessed the willingness to accept this test . The study was design ed to recruit an equal number of African Americans and Caucasians . Results : A total of 2500 participants were recruited from waiting rooms of primary care practice s ; 2165 participants who self-identified as African Americans and Caucasians were included in the analyses . Overall , 56 % had accepted a genotypic test versus 58 % for a phenotypic test . Adjusting for Field Center ( FC ) , age , gender , race , educational attainment , global health rating , and knowledge of the test , the odds ratio of accepting a genotypic versus phenotypic test was 0.85 ( 95 % CI : 0.71 , 1.02 ; P = 0.078 ) . Characteristics associated with test acceptance were age 45–64 years , female gender , Caucasian race , self-rated health less than “ very good ” , and knowledge of the test . Test acceptance was associated with interest in knowing more about health ( 81 % ) and in helping family members ( 71 % ) . Refusal reasons included a need to talk with a doctor ( 44 % ) , concern about privacy ( 32 % ) , and dislike of blood drawing ( 29 % ) . Conclusion : In this diverse sample of primary care patients , stated acceptance of genotypic testing for HH mutations was similar to phenotypic testing for blood iron . Patient education regarding the nature of test , importance of disease detection , and privacy protection appear to be essential for achieving high rates of screening participation OBJECTIVE To examine the relationship between health beliefs and attitudes toward colorectal cancer screening , strength of family history risk , and being appropriately screened for colorectal cancer . METHODS In February 2004 , 7000 r and omly selected members of a multi-specialty group practice located in Boston , MA were mailed a brief survey that was used to ascertain colorectal cancer family history . A follow-up survey that contained questions representing selected constructs of the Health Belief Model , Theory of Planned Behavior , and healthcare experiences was then mailed to all 355 individuals who reported a family history in the initial survey and 710 r and omly selected participants with no colorectal cancer family history . RESULTS Participants who were appropriately screened had higher mean scores for perceived cancer risk , subjective norms , and perceived benefits and lower scores for perceived barriers . Multivariate findings indicate that having high perceptions of risk for colorectal cancer was a significant correlate of being screened appropriately among individuals with a strong family history . CONCLUSIONS For those at greatest colorectal cancer risk due to family history , ensuring that these individuals underst and their personal risk might lead to increased colorectal cancer screening participation . Future intervention research is warranted to examine if raising perceptions of risk can increase screening behaviors in individuals with colorectal cancer risk due to family history Background — Pharmacogenetic-guided dosing of warfarin is a promising application of “ personalized medicine ” but has not been adequately tested in r and omized trials . Methods and Results — Consenting patients ( n=206 ) being initiated on warfarin  were r and omized to pharmacogenetic-guided or st and ard dosing . Buccal swab DNA was genotyped for CYP2C9 * 2 and CYP2C9 * 3 and VKORC1C1173 T with a rapid assay . St and ard dosing followed an empirical protocol , whereas pharmacogenetic-guided dosing followed a regression equation including the 3 genetic variants and age , sex , and weight . Prothrombin time international normalized ratio ( INR ) was measured routinely on days 0 , 3 , 5 , 8 , 21 , 60 , and 90 . A research pharmacist unblinded to treatment strategy managed dose adjustments . Patients were followed up for up to 3 months . Pharmacogenetic-guided predicted doses more accurately approximated stable doses ( P<0.001 ) , result ing in smaller ( P=0.002 ) and fewer ( P=0.03 ) dosing changes and INRs ( P=0.06 ) . However , percent out-of-range INRs ( pharmacogenetic=30.7 % , st and ard=33.1 % ) , the primary end point , did not differ significantly between arms . Despite this , when restricted to wild-type patients ( who required larger doses ; P=0.001 ) and multiple variant carriers ( who required smaller doses ; P<0.001 ) in exploratory analyses , results ( pharmacogenetic=29 % , st and ard=39 % ) achieved nominal significance ( P=0.03 ) . Multiple variant allele carriers were at increased risk of an INR of ≥4 ( P=0.03 ) . Conclusions — An algorithm guided by pharmacogenetic and clinical factors improved the accuracy and efficiency of warfarin dose initiation . Despite this , the primary end point of a reduction in out-of-range INRs was not achieved . In subset analyses , pharmacogenetic guidance showed promise for wild-type and multiple variant genotypes Purpose : To determine the genetics education needs and priorities of dietitians , occupational therapists , physical therapists , psychologists , speech- language -hearing specialists , and social workers . Methods : A r and om sample mail survey of 3600 members of 6 national health professional organizations was undertaken in 1998 and result ed in 1958 responses . Results : A majority worked with clients with genetic conditions , most were providing genetic services to some clients , few had high confidence in providing genetic services , most had little or no education in genetics , and two-thirds wanted continuing education . Conclusion : The study shows a critical need for genetics education of allied and counseling health professionals Genetic testing for an inherited susceptibility to cancer is an emerging technology in medical practice . Little information is currently available about physicians ' attitudes toward these tests . To assess US physicians ' opinions on unresolved issues surrounding genetic testing , a 15‐min survey was administered to a stratified r and om sample of 1,251 physicians from 8 specialties , selected from a file of all licensed physicians in the US ( response rate = 71.0 % ) . Dependent measures included physicians ' attitudes toward genetic counseling and testing qualifications , availability of guidelines , patient confidentiality and insurance discrimination issues , and clinical utility of genetic tests . More than 89 % of physicians reported a need for physician guidelines , 81 % thought that patients with positive genetic test results are at risk for insurance discrimination , and more than 53 % thought that it was difficult to ensure the confidentiality of test results . Almost 25 % indicated that genetic tests for cancer susceptibility have too many inaccurate or ambiguous results ; nearly 75 % thought that clear guidelines are not available for managing patients with positive test results . Only 29 % of physicians reported feeling qualified to provide genetic counseling to their patients . More than 84 % of oncologists considered themselves qualified to recommend genetic testing to their patients compared with 40 % of primary care physicians ( PCPs ) , and 57 % of tertiary care physicians ( TCPs ) . US physicians expressed great uncertainty about issues surrounding genetic testing for cancer susceptibility . Results of this national survey underscore the need to provide physicians with clear guidelines on the use of genetic cancer susceptibility tests and effective medical training on their appropriate implementation . Published 2003 Wiley‐Liss , There is a need to integrate primary - and secondary -care cancer genetic services , but the most appropriate model of service delivery remains unclear . This study reports patients ’ expectations of breast cancer genetic services  and a comparison of their satisfaction with two service models . In the first model , risk assessment was carried out using mailed family history data .  Women estimated as being at high/moderate risk were offered an appointment at the familial breast cancer clinic , and those at low risk were sent a letter of reassurance . In the second model , all women were seen by a genetic nurse specialist , who assessed risk , referred high/moderate-risk women to the above clinic and discharged those at low risk . Over 60 % of all women in the study regarded access to breast screening by mammogram and regular check-ups as very important . This underlines the dem and for a multidisciplinary service providing both clinical genetic and surgical services . Satisfaction was high with both models of service , although significantly lower among women not at increased cancer risk and thus not offered a clinical check-up and mammography . Increased cancer worry was associated with a greater expressed need for information and for reassurance through follow-up clinical checks and mammography . Better targeting of counselling to the expressed concerns and needs of these women is required to improve the service offered . GPs and patients expressed no clear preference for any specific service location or staffing configuration . The novel community service was less expensive in terms of both staff and patient costs . The potential to decrease health staff/patient contact time and to employ nurse practitioners with both clinical genetic and oncology training should be explored further . The rapidly rising dem and for these services suggests that the evaluation of further new models needs to continue to be given priority to guide the development of cancer genetic services Purpose : Little is known about reasons why eligible breast cancer patients decline  BRCA mutation testing . They may withdraw at different stages during genetic counseling for different reasons . We prospect ively studied perceived benefits and barriers to genetic counseling and BRCA testing in 102 newly diagnosed breast cancer patients approached for genetic counseling at the start of radiotherapy . Methods : Patients completed question naires and participated in interviews at different stages of the counseling protocol . Results : Participation was not influenced by distress , knowledge about hereditary breast cancer , previous genetic testing in relatives , or perceived risks and barriers . Immediate decliners ( n = 23 ) do not believe genetic testing is relevant for them . Patients who decline after pedigree compilation ( n = 14 ) are more hesitant and anxious about the influence of the test result on their future often wishing to postpone further testing . Late decliners ( n = 7 ) withdraw afraid of the test result and /or after a relative 's objection . These decliners are not easily identified upon approach because they are similar to patients who receive a DNA test result ( n = 58 ) . Notwithst and ing their decline , 81 % agreed to the timing or would have preferred an earlier approach for genetic counseling . Conclusion : Decliners may make more informed decisions after tailored health education , including adequate risk information Commercial marketing material s may serve as a source of information for physicians about genetic testing for inherited cancer susceptibility ( GTICS ) in addition to medical guidelines , continuing education , and journal articles . The primary purpose s of this study were to : ( 1 ) determine the percentage of physicians who received advertisements for GTICS early in the diffusion of commercial GTICS ( 1999–2000 ) ; ( 2 ) assess associated characteristics ; and ( 3 ) measure the perceived importance of commercial advertisements  and promotions in physicians ' decisions to recommend testing to patients . A nationally representative , stratified r and om sample of 1,251 physicians from the American Medical Association ( AMA ) Physician Masterfile completed a 15–20 min mixed mode question naire that assessed specialty 
    Output:
    
Generally there were modest positive effects on psychological outcomes such as worry and anxiety , behavioral outcomes have shown mixed results , and clinical outcomes were less well studied .
One systematic review , 1 r and omized controlled trial , and 14 other studies assessed consumer information needs and found in general that genetics knowledge was reported to be low but that attitudes were generally positive .