FAMILY PHYSICIANS’ MANAGEMENT OF GENETIC ASPECTS OF A CARDIAC DISEASE: A SCENARIO-BASED STUDY FROM SLOVENIA
Klemenc-Ketiš Z, Peterlin B
*Corresponding Author: Assistant Professor Zalika Klemenc-Ketiš, M.D., Ph.D., Medical Faculty Maribor, Taborska 8, 2000 Maribor, Slovenia. Tel.: +386-41-516-067. Fax: +386-590-30-250. E-mail: zalika.klemenc.ketis@gmail.com
page: 15

INTRODUCTION

Preventive activities are an important part of patient management at primary health level. Taking into account the effect of family and society when dealing with individual patients is also one of the core competencies of family medicine [1]. In the era of rapid evolvement of genetic medicine, family physicians (FPs) increasingly face the activities and dilemmas associated with the management of genetic aspects of disease and prevention [2]. Genetics is rarely taught at the undergraduate and postgraduate level of medical education of non genetic specialities [3]. It has already been shown that FPs had low confidence in their ability to carry out basic medical genetic tasks [4] but were aware of their need for additional education and even expressed their educational needs [5]. Even though family history is a crucial part of patient management in family medicine, its association with possible genetic background of disease development and higher disease risk is not yet fully used in practice [6,7]. Traditionally, family history taking is focused on the patients with symptoms or problems, which might imply that the patient is having a higher risk for the development of some chronic diseases, such as diabetes, coronary disease or asthma [8]. Healthy patients or patients’ relatives are rarely being asked about their family history [9] Also, FPs very rarely decide to refer patients at risk to clinical genetics [10]. Family physicians regularly face ethical dilemmas in their everyday practice [11] and find the management of some of them quite difficult [12]. Genetic medicine is undoubtedly associated with many ethical dilemmas [13]. Similarly, many dilemmas can also be encountered when performing preventive activities such as screening for some diseases [14]. Therefore, the field of genetics in preventive activities performed in patients and their healthy relatives is a very sensitive area. Combined with the lack of knowledge of genetics [15], the FPs may face serious difficulties and doubts, and may feel reluctant to perform such activities even though genetic concepts are clearly part of current FPs practice in form of clinical decision making based on family history [16,17]. This was also shown in a clinical case scenario-based study with more than 60.0% of FPs who were willing to take family history but only 16.0% willing to order a genetic test [18]. Similarly, primary care providers seem to assess breast cancer risk mainly by family history but rarely discuss genetic testing with the patients [10]. In Slovenia, as in many other European countries [3], genetic medicine is taught at the undergraduate level. However, it is not taught as a part of family medicine specialization curriculum [19]. The aim of this study was to find out how Slovenian FPs would manage a hypothetical clinical case and to explore their views about possible ethical dilemmas associated with this clinical case.



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