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Motivating factors for testing in the clinical care of venous thrombosis: a survey of Group Health physicians

The purpose of this survey is to learn more about physicians’ actions and opinions concerning genetic and other tests in the clinical care of venous thrombosis (deep vein thrombosis and pulmonary embolism). The following tests are discussed: Factor V Leiden (an inherited thrombophilia), and lupus anticoagulant or anticardiolipin (an acquired thrombophilia).

The survey is estimated to take approximately 20 minutes.

By completing and returning this survey, I agree that I have reviewed the accompanying information sheet and that the investigators may use these data for research purposes.

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SECTION 1

The following questions refer to past behaviors regarding Factor V Leiden (an inherited thrombophilia) and lupus anticoagulant or ANTICARDIOLIPIN (an acquired thrombophilia) tests in clinical practice.

1.1 Have you ever ordered a test for Factor V Leiden in the setting of venous thrombosis? (Check one.)

(1)YES(2)NO(9)UNSURE

1.2 In clinical practice, what would be your primary reasons for ordering the Factor V Leidentest in the context of venous thrombosis? (Check all that apply and among those checked, rank in order from most to least compelling.)

Check / Rank (1 = most compelling)
______ / 1.2.1 Make a diagnosis of venous thrombosis
______ / 1.2.2 Advise patients about risk of recurrence
______ / 1.2.3 Make treatment decisions (e.g., use or duration of anticoagulation, use of prophylactic anticoagulation, or use of other drugs such as hormones)
______ / 1.2.4 Make clinical decisions about venous thrombosis prevention
______ / 1.2.5 Explain the occurrence of venous thrombosis
______ / 1.2.6 Satisfy a patient request
______ / 1.2.7 Teach medical students, residents, etc.
______ / 1.2.8 Other (write out):
______ / 1.2.9 None of the above

1.3 Compared to other doctors with similar case loads, would you estimate that you order MORE, FEWER, or ABOUT THE SAME NUMBER of Factor V Leiden tests than they do?

(1)More tests

(2)Fewer tests

(3)About the same number of tests

(9)Don’t know

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1.4 Have you ever ordered a test for lupus anticoagulant or ANTICARDIOLIPIN in the context of venous thrombosis? (Check one.)

(1)YES(2)NO(9)UNSURE

1.5 In clinical practice, what would be your primary reasons for ordering a lupus anticoagulant or ANTICARDIOLIPIN test in the context of venous thrombosis? (Check all that apply and among those checked, rank in order from most to least compelling.)

Check / Rank (1 = most compelling)
______ / 1.5.1 Make a diagnosis of venous thrombosis
______ / 1.5.2 Advise patients about risk of recurrence
______ / 1.5.3 Make treatment decisions (e.g., use or duration of anticoagulation, use of prophylactic anticoagulation, or use of other drugs such as hormones)
______ / 1.5.4 Make clinical decisions about venous thrombosis prevention
______ / 1.5.5 Explain the occurrence of venous thrombosis
______ / 1.5.6 Satisfy a patient request
______ / 1.5.7 Teach medical students, residents, etc.
______ / 1.5.8 Other (write out):
______ / 1.5.9 None of the above

1.6 Compared to other doctors with similar case loads, would you estimate that you order MORE, FEWER, or ABOUT THE SAME NUMBER of lupus anticoagulant or ANTICARDIOLIPIN tests than they do?

(1)More tests

(2)Fewer tests

(3)About the same number of tests

(9)Don’t know

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SECTION 2

When deciding whether to order a Factor V Leiden test, how important would the following factors be to you? In the right-hand column, check the boxes that correspond to the three most compelling statements.

Factor / Very
High / High / Fair / Low / Very
Low / What are the 3 most compelling factors?
2.1 Age / (1) / (2) / (3) / (4) / (5)
2.2 Gender / (1) / (2) / (3) / (4) / (5)
2.3 Personal history of venous thrombosis / (1) / (2) / (3) / (4) / (5)
2.4 Family history of venous thrombosis / (1) / (2) / (3) / (4) / (5)
2.5 Family history of arterial thrombosis / (1) / (2) / (3) / (4) / (5)
2.6 Site of venous thrombosis / (1) / (2) / (3) / (4) / (5)
2.7 Presence of established risk factors for venous thrombosis (e.g., cancer, immobility) / (1) / (2) / (3) / (4) / (5)
2.8 Consultation with a specialist / (1) / (2) / (3) / (4) / (5)
2.9 Group Health guidelines / (1) / (2) / (3) / (4) / (5)
2.10 Professional society guidelines (CAP, ACMG, ACCP) / (1) / (2) / (3) / (4) / (5)
2.11 Patient preference or request / (1) / (2) / (3) / (4) / (5)
2.12 Patient access to genetic counseling / (1) / (2) / (3) / (4) / (5)
2.13 Inclusion of FVL test on a thrombophilia panel / (1) / (2) / (3) / (4) / (5)
2.14 Other (write in): / (1) / (2) / (3) / (4) / (5)

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SECTION 3

The following questions refer to several hypothetical clinical scenarios. Please estimate the likelihood that you would order a Factor V Leiden for such a patient. To the right, check one box that indicates the primary reason why you would or would not order the test.

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Please estimate the likelihood that you would order a LUPUS ANTICOAGULANT or anticardiolipin for such a patient. To the right, check one box that indicates the primary reason why you would or would not order the test.

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SECTION 4

A range of opinions exists about possible barriers to integration of genetic testing in clinical care. Please check the appropriate box. In the right-hand column, check the boxes that correspond to the three most compelling statements.

Statement / Strongly agree / Agree / Undecided /unsure / Disagree / Strongly disagree / What are the 3 most compelling reasons?
4.1 I don’t see enough patients for whom genetic testing would be applicable / (1) / (2) / (3) / (4) / (5)
4.2 It is unclear whether the test result would alter patient management / (1) / (2) / (3) / (4) / (5)
4.3 Sensitivity or specificity of the test are too low / (1) / (2) / (3) / (4) / (5)
4.4 Current guidelines at GHC do not encourage genetic testing / (1) / (2) / (3) / (4) / (5)
4.5 Current guidelines from professional societies do not encourage genetic testing / (1) / (2) / (3) / (4) / (5)
4.6 Patients must first express an interest in the test / (1) / (2) / (3) / (4) / (5)
4.7 Genetic testing is not necessary because a family history tells me similar information / (1) / (2) / (3) / (4) / (5)
4.8 It is inconvenient (for either patients or practitioners) to obtain the test / (1) / (2) / (3) / (4) / (5)
4.9 Genetic counseling services are not well integrated into my practice / (1) / (2) / (3) / (4) / (5)
4.10 I am concerned about my patients’ privacy/ confidentiality of genetic test results / (1) / (2) / (3) / (4) / (5)
4.11 I am concerned about potential genetic discrimination based on my patients’ genetic test results / (1) / (2) / (3) / (4) / (5)

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SECTION 5

The following questions ask about practices and skills related to Factor V Leiden testing.

Very high / High / Fair / Low / Very low
5.1 How would you rate your confidence in determining when it is appropriate to test for Factor V Leiden? / (1) / (2) / (3) / (4) / (5)
5.2 How would you rate your confidence in interpreting the results of Factor V Leiden tests? / (1) / (2) / (3) / (4) / (5)
5.3 How would you rate your confidence in communicating information about the results of Factor V Leiden tests to your patients? / (1) / (2) / (3) / (4) / (5)

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The following questions ask about provider and practice characteristics.

6.1 What is your area of practice? (Choose one.)

(1)Internal medicine

(2)Family medicine

(3)Hematology/oncology

(4)OB/GYN

(5)Other (Please describe.) ______

6.2 What year did you complete medical school? ______

6.3 What year did you complete residency?______

6.4 Did you receive your medical degree from a medical school in the United States?

(1)Yes

(0)No

6.5 During a typical year, how many patients with venous thrombosis do you see?

______patients per year

6.6 What is your age? ______ years old

6.7 What is your gender? (Check one.)

(1)Female

(2)Male

6.8 How is your time allocated among the following activities (percentages should add up to 100%):

Practice ______%

Research ______%

Administration ______%

Teaching ______%

Other______%(Please specify: ______)

6.9 Additional comments: