{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T15:36:28Z","timestamp":1786980988782,"version":"build-2736575974"},"reference-count":27,"publisher":"Springer Science and Business Media LLC","issue":"4","license":[{"start":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T00:00:00Z","timestamp":1760400000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T00:00:00Z","timestamp":1760400000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"AstraZeneca","award":["aznl202300195"],"award-info":[{"award-number":["aznl202300195"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Familial Cancer"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Only 67% of eligible patients with breast cancer currently undergo genetic testing. Mainstream genetic testing (i.e. healthcare professionals (HCPs) from outside the genetics field providing genetic counselling), also referred to asmainstreaming, leads to increased uptake of genetic testing. Unlike surgical oncologists, medical oncologists have not yet widely adopted mainstreaming. This study aims to identify barriers and facilitators for HCPs, in particular medical oncologists, in advancing the implementation of mainstreaming. Structured interviews were conducted with HCPs (predominantly medical oncologists) using the Constructive Technology Assessment (CTA) framework. Participants were recruited from all regions of the Netherlands, ensuring representation from academic medical centres, teaching hospitals and general hospitals. The interview data was analysed using thematic analysis. In this qualitative study, 12 medical oncologists, three nurse practitioners, three clinical geneticists, two clinical laboratory geneticists and one representative of a health insurer were interviewed. Lack of time and limited knowledge were the most commonly mentioned barriers, whilst effective cross-departmental collaboration and education were the most important facilitators. For medical oncologists specifically, financial compensation for the increased workload and the increasing importance of genetic testing for guiding therapy choices were found to be encouraging factors. This study identified several barriers and facilitators to mainstreaming being implemented by medical oncologists. Education to strengthen oncologists\u2019 skills in discussing germline genetic testing may address knowledge gaps and time barriers. Alongside cross-departmental collaboration, these strategies could streamline genetic testing pathways. Further research should evaluate their implementation and effects on patient experience and equitable access.<\/jats:p>","DOI":"10.1007\/s10689-025-00500-9","type":"journal-article","created":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T10:13:09Z","timestamp":1760436789000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Barriers and facilitators for medical oncologists in the further implementation of mainstream genetic testing in breast cancer care in the Netherlands"],"prefix":"10.1007","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-1630-905X","authenticated-orcid":false,"given":"Chiem L","family":"de Jong","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gina","family":"Schijven","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0016-4972","authenticated-orcid":false,"given":"Ellen G","family":"Engelhardt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7713-1450","authenticated-orcid":false,"given":"Agnes","family":"Jager","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0305-3477","authenticated-orcid":false,"given":"Margreet G. E. M.","family":"Ausems","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,10,14]]},"reference":[{"issue":"8","key":"500_CR1","doi-asserted-by":"publisher","first-page":"1194","DOI":"10.1093\/annonc\/mdz173","volume":"30","author":"F Cardoso","year":"2019","unstructured":"Cardoso F, Kyriakides S, Ohno S et al (2019) Early breast cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 30(8):1194\u20131220. https:\/\/doi.org\/10.1093\/annonc\/mdz173","journal-title":"Ann Oncol"},{"key":"500_CR2","doi-asserted-by":"publisher","unstructured":"Daly MB, Pal T, Berry MP Genetic\/Familial High-Risk Assessment: Breast, Ovarian, and, Pancreatic et al (2021) Version 2.2021, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. ;19(1):77\u2013102. https:\/\/doi.org\/10.6004\/jnccn.2021.0001","DOI":"10.6004\/jnccn.2021.0001"},{"issue":"1","key":"500_CR3","doi-asserted-by":"publisher","first-page":"281","DOI":"10.1245\/s10434-020-09123-z","volume":"28","author":"JJ Alberty-Oller","year":"2021","unstructured":"Alberty-Oller JJ, Weltz S, Santos A et al (2021) Adherence to NCCN guidelines for genetic testing in breast cancer patients: who are we missing? Ann Surg Oncol 28(1):281\u2013286. https:\/\/doi.org\/10.1245\/s10434-020-09123-z","journal-title":"Ann Surg Oncol"},{"issue":"1","key":"500_CR4","doi-asserted-by":"publisher","first-page":"129","DOI":"10.1186\/s13058-025-02081-y","volume":"27","author":"CL Jong","year":"2025","unstructured":"Jong CL, Siesling S, Puts GCWM, Jager A, Ausems MGEM (2025) The impact of a mainstream genetic testing pathway and socioeconomic factors on the uptake of germline genetic testing in breast cancer patients: results of the nationwide GENE-SMART study. Breast Cancer Res 27(1):129. https:\/\/doi.org\/10.1186\/s13058-025-02081-y","journal-title":"Breast Cancer Res"},{"key":"500_CR5","doi-asserted-by":"publisher","first-page":"29506","DOI":"10.1038\/srep29506","volume":"6","author":"A George","year":"2016","unstructured":"George A, Riddell D, Seal S et al (2016) Implementing rapid, robust, cost-effective, patient-centred, routine genetic testing in ovarian cancer patients. Sci Rep 6:29506. https:\/\/doi.org\/10.1038\/srep29506","journal-title":"Sci Rep"},{"issue":"5","key":"500_CR6","doi-asserted-by":"publisher","first-page":"e194428","DOI":"10.1001\/jamanetworkopen.2019.4428","volume":"2","author":"Z Kemp","year":"2019","unstructured":"Kemp Z, Turnbull A, Yost S et al (2019) Evaluation of cancer-based criteria for use in mainstream BRCA1 and BRCA2 genetic testing in patients with breast cancer. JAMA Netw Open 2(5):e194428. https:\/\/doi.org\/10.1001\/jamanetworkopen.2019.4428","journal-title":"JAMA Netw Open"},{"issue":"4","key":"500_CR7","doi-asserted-by":"publisher","first-page":"467","DOI":"10.1007\/s10689-023-00342-3","volume":"22","author":"TS Chai","year":"2023","unstructured":"Chai TS, Yin K, Wooters M, Shannon KM, Hughes KS (2023) Mainstreamed genetic testing of breast cancer patients: experience from a single surgeon\u2019s practice in a large US academic center. Fam Cancer 22(4):467\u2013474. https:\/\/doi.org\/10.1007\/s10689-023-00342-3","journal-title":"Fam Cancer"},{"issue":"5","key":"500_CR8","doi-asserted-by":"publisher","first-page":"872","DOI":"10.1038\/s41431-021-00848-3","volume":"29","author":"C Beard","year":"2021","unstructured":"Beard C, Monohan K, Cicciarelli L, James PA (2021) Mainstream genetic testing for breast cancer patients: early experiences from the Parkville Familial cancer centre. Eur J Hum Genet 29(5):872\u2013880. https:\/\/doi.org\/10.1038\/s41431-021-00848-3","journal-title":"Eur J Hum Genet"},{"issue":"2","key":"500_CR9","doi-asserted-by":"publisher","first-page":"133","DOI":"10.1007\/s10689-020-00160-x","volume":"19","author":"EM Grindedal","year":"2020","unstructured":"Grindedal EM, J\u00f8rgensen K, Olsson P et al (2020) Mainstreamed genetic testing of breast cancer patients in two hospitals in South Eastern Norway. Fam Cancer 19(2):133\u2013142. https:\/\/doi.org\/10.1007\/s10689-020-00160-x","journal-title":"Fam Cancer"},{"issue":"6","key":"500_CR10","doi-asserted-by":"publisher","first-page":"3248","DOI":"10.1245\/s10434-023-13229-5","volume":"30","author":"K Bokkers","year":"2023","unstructured":"Bokkers K, Bleiker EMA, Aalfs CM et al (2023) Surgical oncologists and nurses in breast cancer care are ready to provide Pre-Test genetic counseling. Ann Surg Oncol 30(6):3248\u20133258. https:\/\/doi.org\/10.1245\/s10434-023-13229-5","journal-title":"Ann Surg Oncol"},{"issue":"2","key":"500_CR11","doi-asserted-by":"publisher","first-page":"262","DOI":"10.1001\/jamaoncol.2016.3346","volume":"3","author":"P Niravath","year":"2017","unstructured":"Niravath P, Cakar B, Ellis M (2017) The role of genetic testing in the selection of therapy for breast cancer: A review. JAMA Oncol 3(2):262. https:\/\/doi.org\/10.1001\/jamaoncol.2016.3346","journal-title":"JAMA Oncol"},{"issue":"25","key":"500_CR12","doi-asserted-by":"publisher","first-page":"2394","DOI":"10.1056\/NEJMoa2105215","volume":"384","author":"ANJ Tutt","year":"2021","unstructured":"Tutt ANJ, Garber JE, Kaufman B et al (2021) Adjuvant olaparib for patients with BRCA1- or BRCA2-Mutated breast cancer. N Engl J Med 384(25):2394\u20132405. https:\/\/doi.org\/10.1056\/NEJMoa2105215","journal-title":"N Engl J Med"},{"issue":"3","key":"500_CR13","doi-asserted-by":"publisher","first-page":"293","DOI":"10.1007\/s10689-019-00122-y","volume":"18","author":"N Hallowell","year":"2019","unstructured":"Hallowell N, Wright S, Stirling D, Gourley C, Young O, Porteous M (2019) Moving into the mainstream: healthcare professionals\u2019 views of implementing treatment focussed genetic testing in breast cancer care. Fam Cancer 18(3):293\u2013301. https:\/\/doi.org\/10.1007\/s10689-019-00122-y","journal-title":"Fam Cancer"},{"issue":"2","key":"500_CR14","doi-asserted-by":"publisher","first-page":"162","DOI":"10.1017\/S0266462307070262","volume":"23","author":"KF Douma","year":"2007","unstructured":"Douma KF, Karsenberg K, Hummel MJ, Bueno-de-Mesquita JM, van Harten WH (2007) Methodology of constructive technology assessment in health care. Int J Technol Assess Health Care 23(2):162\u2013168. https:\/\/doi.org\/10.1017\/S0266462307070262","journal-title":"Int J Technol Assess Health Care"},{"issue":"5","key":"500_CR15","doi-asserted-by":"publisher","first-page":"513","DOI":"10.1586\/erp.11.60","volume":"11","author":"F Xie","year":"2011","unstructured":"Xie F, Bowen JM, Sutherland SC, Burke N, Blackhouse G, Tarride JE et al (2011) Using health technology assessment to support evidence-based decision-making in canada: an academic perspective. Expert Rev Pharmacoecon Outcomes Res 11(5):513\u2013521. https:\/\/doi.org\/10.1586\/erp.11.60","journal-title":"Expert Rev Pharmacoecon Outcomes Res"},{"issue":"2","key":"500_CR16","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1191\/1478088706qp063oa","volume":"3","author":"V Braun","year":"2006","unstructured":"Braun V, Clarke V (2006) Using thematic analysis in psychology. Qual Res Psychol 3(2):77\u2013101. https:\/\/doi.org\/10.1191\/1478088706qp063oa","journal-title":"Qual Res Psychol"},{"issue":"5","key":"500_CR17","doi-asserted-by":"publisher","first-page":"1080","DOI":"10.1002\/jgc4.1579","volume":"31","author":"YQ Lee","year":"2022","unstructured":"Lee YQ, Yoon SY, Hassan T, Padmanabhan H, Yip CH, Keng WT et al (2022) Attitudes and training needs of oncologists and surgeons in mainstreaming breast cancer genetic counseling in a low-to-middle income Asian country. J Genet Couns 31(5):1080\u20131089. https:\/\/doi.org\/10.1002\/jgc4.1579","journal-title":"J Genet Couns"},{"issue":"4","key":"500_CR18","doi-asserted-by":"publisher","first-page":"1059","DOI":"10.3390\/cancers14041059","volume":"14","author":"K Bokkers","year":"2022","unstructured":"Bokkers K, Vlaming M, Engelhardt EG et al (2022) The feasibility of implementing mainstream germline genetic testing in routine cancer care: a systematic review. Cancers (Basel) 14(4):1059. https:\/\/doi.org\/10.3390\/cancers14041059","journal-title":"Cancers (Basel)"},{"issue":"7","key":"500_CR19","doi-asserted-by":"publisher","first-page":"1149","DOI":"10.1038\/s41436-020-0785-6","volume":"22","author":"S White","year":"2020","unstructured":"White S, Jacobs C, Phillips J (2020) Mainstreaming genetics and genomics: a systematic review of the barriers and facilitators for nurses and physicians in secondary and tertiary care. Genet Med 22(7):1149\u20131155. https:\/\/doi.org\/10.1038\/s41436-020-0785-6","journal-title":"Genet Med"},{"issue":"1","key":"500_CR20","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1016\/j.cgh.2022.10.025","volume":"21","author":"NJ Rodriguez","year":"2023","unstructured":"Rodriguez NJ, Ricker C, Stoffel EM, Syngal S (2023) Barriers and facilitators to genetic education, risk assessment, and testing: considerations on advancing equitable genetics care. Clin Gastroenterol Hepatol 21(1):3\u20137. https:\/\/doi.org\/10.1016\/j.cgh.2022.10.025","journal-title":"Clin Gastroenterol Hepatol"},{"issue":"1","key":"500_CR21","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1186\/s13053-022-00238-w","volume":"20","author":"K Bokkers","year":"2022","unstructured":"Bokkers K, Bleiker EMA, Hoogendam JP et al (2022) Mainstream genetic testing for women with ovarian cancer provides a solid basis for patients to make a well-informed decision about genetic testing. Hered Cancer Clin Pract 20(1):33. https:\/\/doi.org\/10.1186\/s13053-022-00238-w","journal-title":"Hered Cancer Clin Pract"},{"issue":"3","key":"500_CR22","doi-asserted-by":"publisher","first-page":"295","DOI":"10.1007\/s10689-021-00277-7","volume":"21","author":"K Bokkers","year":"2022","unstructured":"Bokkers K, Zweemer RP, Koudijs MJ et al (2022) Positive experiences of healthcare professionals with a mainstreaming approach of germline genetic testing for women with ovarian cancer. Fam Cancer 21(3):295\u2013304. https:\/\/doi.org\/10.1007\/s10689-021-00277-7","journal-title":"Fam Cancer"},{"issue":"1","key":"500_CR23","doi-asserted-by":"publisher","first-page":"221","DOI":"10.1016\/j.ygyno.2020.07.027","volume":"159","author":"CB Powell","year":"2020","unstructured":"Powell CB, Laurent C, Ciaravino G et al (2020) Streamlining genetic testing for women with ovarian cancer in a Northern California health care system. Gynecol Oncol 159(1):221\u2013228. https:\/\/doi.org\/10.1016\/j.ygyno.2020.07.027","journal-title":"Gynecol Oncol"},{"issue":"2","key":"500_CR24","doi-asserted-by":"publisher","first-page":"431","DOI":"10.1016\/j.ygyno.2020.05.001","volume":"158","author":"M Gleeson","year":"2020","unstructured":"Gleeson M, Kentwell M, Meiser B et al (2020) The development and evaluation of a nationwide training program for oncology health professionals in the provision of genetic testing for ovarian cancer patients. Gynecol Oncol 158(2):431\u2013439. https:\/\/doi.org\/10.1016\/j.ygyno.2020.05.001","journal-title":"Gynecol Oncol"},{"key":"500_CR25","doi-asserted-by":"publisher","first-page":"e2400167","DOI":"10.1200\/PO.24.00167","volume":"8","author":"C Cremin","year":"2024","unstructured":"Cremin C, Bedard AC, Hong Q et al (2024) Improving access to hereditary testing in pancreatic ductal carcinoma. JCO Precis Oncol 8:e2400167. https:\/\/doi.org\/10.1200\/PO.24.00167","journal-title":"JCO Precis Oncol"},{"issue":"3","key":"500_CR26","doi-asserted-by":"publisher","first-page":"272","DOI":"10.1111\/j.1365-2354.2005.00574.x","volume":"14","author":"A Ardern-Jones","year":"2005","unstructured":"Ardern-Jones A, Kenen R, Eeles R (2005) Too much, too soon? Patients and health professionals\u2019 views concerning the impact of genetic testing at the time of breast cancer diagnosis in women under the age of 40. Eur J Cancer Care (Engl) 14(3):272\u2013281. https:\/\/doi.org\/10.1111\/j.1365-2354.2005.00574.x","journal-title":"Eur J Cancer Care (Engl)"},{"issue":"6","key":"500_CR27","doi-asserted-by":"publisher","first-page":"1380","DOI":"10.1007\/s10897-018-0261-5","volume":"27","author":"S Wright","year":"2018","unstructured":"Wright S, Porteous M, Stirling D et al (2018) Patients\u2019 views of treatment-focused genetic testing: lessons for the mainstreaming of BRCA1 and BRCA2 testing. J Genet Couns 27(6):1380\u20131389. https:\/\/doi.org\/10.1007\/s10897-018-0261-5","journal-title":"J Genet Couns"}],"updated-by":[{"DOI":"10.1007\/s10689-025-00510-7","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2025,11,18]],"date-time":"2025-11-18T00:00:00Z","timestamp":1763424000000}}],"container-title":["Familial Cancer"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10689-025-00500-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10689-025-00500-9\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10689-025-00500-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,6]],"date-time":"2025-12-06T08:17:30Z","timestamp":1765009050000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s10689-025-00500-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,14]]},"references-count":27,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["500"],"URL":"https:\/\/doi.org\/10.1007\/s10689-025-00500-9","relation":{},"ISSN":["1573-7292"],"issn-type":[{"value":"1573-7292","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,14]]},"assertion":[{"value":"23 June 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 September 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 October 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 November 2025","order":5,"name":"change_date","label":"Change Date","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Correction","order":6,"name":"change_type","label":"Change Type","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"A Correction to this paper has been published:","order":7,"name":"change_details","label":"Change Details","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"https:\/\/doi.org\/10.1007\/s10689-025-00510-7","URL":"https:\/\/doi.org\/10.1007\/s10689-025-00510-7","order":8,"name":"change_details","label":"Change Details","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"CLdJ, GS and AJ and EGE declare that they have no conflicts of interest. MGEMA received consulting fees from AstraZeneca for participation in an international Steering Committee to give advice on a Train-The-Trainer programme and a honorarium for a lecture on genetic testing in breast cancer. These payments were made to the institution (University Medical Center Utrecht).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"Written informed consent was obtained from all participants. Participants were told that participation was voluntary and that the results of the interviews would be anonymised before publication. This study does not fall under the scope of the Dutch Medical Research Involving Human Subjects Act (WMO). It therefore does not require approval from an accredited medical ethics committee in the Netherlands. However, an independent quality check has been carried at UMC Utrecht out to ensure compliance with legislation and regulations, as well as looking at informed consent procedure, data management, privacy aspects and legal aspects.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}],"article-number":"75"}}