{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T05:13:14Z","timestamp":1782450794522,"version":"3.54.5"},"reference-count":24,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2017,1,16]],"date-time":"2017-01-16T00:00:00Z","timestamp":1484524800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2017,1,16]],"date-time":"2017-01-16T00:00:00Z","timestamp":1484524800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"}],"funder":[{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"publisher","award":["5U38GD00054"],"award-info":[{"award-number":["5U38GD00054"]}],"id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"publisher","award":["51U58DP003798"],"award-info":[{"award-number":["51U58DP003798"]}],"id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Journal of Genetic Counseling"],"published-print":{"date-parts":[[2017,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Genetic counseling (GC) and genetic testing (GT) identifies high\u2010risk individuals who benefit from enhanced medical management. Not all individuals undergo GT following GC and understanding the reasons why can impact clinical efficiency, reduce GT costs through appropriate identification of high\u2010risk individuals, and demonstrate the value of pre\u2010GT GC. A collaborative project sponsored by the Michigan Department of Health and Human Services prospectively collects anonymous data on <jats:italic>BRCA<\/jats:italic>\u2010related GC visits performed by providers in Michigan, including demographics, patient\/family cancer history, GT results, and reasons for declining GT. From 2008 to 2012, 10,726 patients underwent GC; 3476 (32.4%) did not pursue GT. Primary reasons included: not the best test candidate (28.1%), not clinically indicated (23.3%), and insurance\/out of pocket cost concerns (13.6%). Patient disinterest was the primary reason for declining in 17.1%. Insurance\/out of pocket cost concerns were the primary reason for not testing in 13.4% of untested individuals with private insurance. Among untested individuals with breast and\/or ovarian cancer, 22.5% reported insurance\/out of pocket cost concerns as the primary reason for not testing and 6.6% failed to meet Medicare criteria. In a five\u2010year time period, nearly one\u2010third of patients who underwent <jats:italic>BRCA<\/jats:italic> GC did not pursue GT. GT was not indicated in almost half of patients. Insurance\/out of pocket cost concerns continue to be barriers.<\/jats:p>","DOI":"10.1007\/s10897-016-0064-5","type":"journal-article","created":{"date-parts":[[2017,1,16]],"date-time":"2017-01-16T12:24:05Z","timestamp":1484569445000},"page":"859-865","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":33,"title":["Large, Prospective Analysis of the Reasons Patients Do Not Pursue <i>BRCA<\/i> Genetic Testing Following Genetic Counseling"],"prefix":"10.1002","volume":"26","author":[{"given":"Sommer","family":"Hayden","sequence":"first","affiliation":[{"name":"Saint Joseph Mercy Hospital Ann Arbor MI USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Mange","sequence":"additional","affiliation":[{"name":"Michigan Department of Health and Human Services Lansing MI USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Debra","family":"Duquette","sequence":"additional","affiliation":[{"name":"Michigan Department of Health and Human Services Lansing MI USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nancie","family":"Petrucelli","sequence":"additional","affiliation":[{"name":"Barbara Ann Karmanos Cancer Institute Detroit MI USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victoria M.","family":"Raymond","sequence":"additional","affiliation":[{"name":"University of Michigan Health System 300 North Ingalls, NI3 A08 Ann Arbor MI 48109\u20105419 USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"on behalf of the BRCA Clinical Network Partners","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,1,16]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-143-5-200509060-00011"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1038\/gim.2015.41"},{"issue":"11","key":"e_1_2_13_4_1","first-page":"1251","article-title":"Factors associated with decisions about clinical BRCA1\/2 testing","volume":"9","author":"Armstrong K.","year":"2000","journal-title":"Cancer Epidemiology, Biomarkers & Prevention : A Publication of the American Association for Cancer Research, Cosponsored by the American Society of Preventive Oncology"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1038\/gim.2013.181"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2006.09.1066"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2005.03.6772"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0142(19960601)77:11<2318::AID-CNCR21>3.0.CO;2-Z"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1038\/ncponc0384"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1089\/gte.2006.9998"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.1999.17.5.1595"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10897-005-0384-3"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199901143400201"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/93.21.1633"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.1089\/gte.2006.9999"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.1126\/science.1088759"},{"key":"e_1_2_13_17_1","unstructured":"Lee J.(2013).Cigna requires genetic counseling to end inappropriate testing.Modern Healthcare. 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