Even though the majority of primary care providers believe that genetic disease risk tests can help patients, many doctors are hesitant about ordering them, new research has found. The survey, published in Precision Medicine, asked 488 primary care providers about their views on using genetic tests to predict a patient’s risk of disease. The study found that while doctors were typically supportive of the tests and believed that they could improve patient health, they were unlikely to order any themselves because of concerns about costs and result interpretation.

The survey, which evaluated the opinions of 488 community and academic doctors in New York City, found that 74% of respondents believed that genetic testing for risk factors of certain diseases was clinically useful. 70% of participants said that they expected such testing would improve treatment outcomes for patients within the next five years.

However, despite such positive opinions, the study also found that only a third of the participants had ordered a genetic test, returned results to patients, or referred patients for genetic counselling in the last twelve months. This wasn’t necessarily a result of a lack of understanding or knowledge of the tests; roughly 80% of the respondents reported that they had received formal genetics training.

Instead, the study appears to show that financial concerns may be contributing to hesitance when using these tests. A large majority of respondents (roughly 80%) said that they didn’t think genetic tests would be covered by health insurance providers within the next five years and 50% of the participants voiced concerns that test results may be used to charge higher insurance premiums or deny coverage from patients with high risk factors.

A second study, also published in Precision Medicine this month, investigated insurance spending on genetic tests between 2014 and 2016. This included money paid by insurers themselves and any out-of-pocket expenses for patients. They found that while the number of tests on the market was roughly 75,000 (in August 2017) and was increasing dramatically, the amount and extent of insurance coverage was tremendously varied. Multi-gene tests in particular rarely received extensive insurance coverage.

 “If insurance does not cover costs, this can further widen disparities in access to genetic testing by keeping them the purview of patients who have more resources,” Dr Carol Horowitz, senior author of the first study, told Reuters. “As it stands, low-income, minority patients are most likely to suffer from chronic diseases. These priority populations should not be the last to benefit from advances in genetics, or it will just be another example of ways health systems can inadvertently widen the disparities so many of us are committed to eliminating.”

Insurance was not the only concern raised by the survey; roughly 75% of participants said that they were mistrustful of genetic testing companies and 50% believed that informing their patients about their risk factors would cause excessive stress. At the same time, a large number of respondents stated that they were not confident in their ability to interpret test results accurately or effectively, despite any formal training they may have had.