Attitudes of Australian dermatologists on the use of genetic testing: A cross-sectional survey with a focus on melanoma

A recent nation-wide survey of Australian Dermatologists has provided insight into the current use, confidence, attitudes, and education preferences for genetic testing in dermatology practice.

The survey focused on genetic testing for familial melanoma, as commercial panel genetic tests are currently available for melanoma risk, however little is known about dermatologists’ perceptions regarding the utility of testing. The European Union funded iToBoS project aims to integrate personal genetic data along with clinical information and image analysis tools to provide holistic risk stratification for melanoma. Prior to wider implementation, it is important to evaluate the current perceptions and confidence of dermatologists regarding the use of genomics in their practice.

The 37-item survey was returned by just over half (56%, 256/461) of all accredited members of the Australian College of Dermatologists. When asked about perceived relevance that genetic testing has to their current dermatology practice, 44% of respondents either agreed, or strongly agreed it was relevant to their practice today. However, opinion of relevance of genetic testing to future practice was significantly higher at 84%.

Survey respondents were asked specifically about the perceived benefits and limitations of genetic testing for melanoma risk. Majority of respondents agreed that testing could be of value for the patient (93%), their family (96%), informing management decisions (90%) and for improving primary/secondary prevention of melanoma (90%). There was also strong agreeance with perceived limitations of genetic testing, including that it could limit a patient’s health insurance (79%) and life insurance (84%) coverage, and could stigmatise patients as a “worried well” person (58%).

When asked about what genetic tasks were already being performed in the clinic, it was found that majority of respondents had previously discussed, offered, or ordered genetic testing at least once previously for their patients. However, the frequency of test ordering was very low, with 93% of respondents stating they either rarely or never order testing. Relating to this, only 19% of survey respondents agreed that they had adequate resources to offer genetic testing to patients. The most common reason provided for infrequent test ordering was a perceived lack of relevance to practice, a lack of confidence, or a lack of access to genetic services.

Survey respondents were asked to rate their confidence in performing certain genetic tasks, and it was unsurprising that confidence was high for tasks relating to recording family history and identifying patients at risk of hereditary conditions. Such processes have been relevant to medical practice generally, and dermatology specifically for an extended period. Lowest confidence was reported for tasks related to ordering genetic tests and interpreting the results.

The survey also collected information on previous education in genomics and found that less than a quarter of respondents have completed a unit or short course in genetics or received training on ethical considerations. When asked to rank their preferences for future learning modalities, face-to-face courses ranked the highest, followed closely by a hotline for genetics advice, and an online course.

The final question of the survey was open-ended and invited any feedback from respondents. About a third of respondents provided an answer, of which, half the comments related to the need or an interest in further training and/or resources for providing genetic testing in clinical practice.

Overall, the survey results have indicated that Australian Dermatologists widely recognise the relevance of genetic testing to their future practice. The survey has been valuable in identifying areas of need for training, such as protocols for ordering genetic tests and interpreting results. Furthermore, there is feedback on preferences for future training initiatives for upskilling in this area.

The original article reporting the results of this survey can be accessed using the following link