THE INNER CURRICULUM: LEARNING AND CHANGE BY PHYSICIAN ± PATIENTS WITH CANCER. E.K. Fromme 1 , J.A. Carrese 1 , R.S. Hebert 1 ; 1 Johns Hopkins University, Baltimore, MD PURPOSE: A common notion, exemplified in the 1991 motion picture The Doctor, is that physicians who experience serious illness themselves can learn to be more caring and therefore better physicians. This qualitative study examined what physicians with cancer learned from their illnesses and whether they felt the way they practiced medicine changed as a result. METHODS: Physicians who had a previous diagnosis of cancer other than non-melanoma skin cancer were recruited by their oncologists or radiation oncologists. 24 physician subjects representing diverse spectra of race, age, specialty, career stage and practice setting were identified. Various disease stages and tumor types were represented, from incidentally identified carcinoma to imminently terminal metastatic carcinoma. Subjects participated in in-depth semistructured interviews lasting an hour and a half. The interview questions were based on a literature review of writings by physicians with cancer and other illnesses in journal citations identified in MEDLINE. Interview transcripts were independently coded by two readers and compared for agreement. Content analysis identified several major learning themes. Relationships between themes were examined and organized conceptually. RESULTS: Physicians' learning led to perceived changes in 4 main areas: (1) Understanding what patients are going through. Physicians better understood the patient's perspective, for example the anxiety created by waiting for test results or delayed surgery. (2) In some cases, this understanding was accompanied by changes in empathy that manifested as a felt connection to patients or a greater sensitivity to patients' emotions. (3) Changes in communication such as repeating important information, being careful not to minimize illness, and striving to deliver bad news skillfully. (4) Changes in values and priorities such as setting limits with employers and difficult patients, appreciating family, and acknowledging the possibility of death. CONCLUSION: Experience with a serious illness is a powerful source of learning for many physicians. In some cases, their experiences caused changes in their attitudes, their communication, and other aspects of their medical practice. Educators interested in teaching about patient centered care might utilize the experience and insights of physician patients. PURPOSE: There is a well-documented interest in genetic susceptibility testing among firstdegree relatives of women with breast cancer. Interest in, and uptake of, testing has been shown to remain high despite education regarding risks and limitations of testing suggesting unknown factors influencing the decision to test. The purpose of this study was to explore factors influencing interest in genetic testing for breast cancer. METHODS: A qualitative study design exploring interest in genetic testing was chosen to allow us to establish the appropriate parameters for future intervention research. We conducted 4 focus groups with 10 ± 12 participants each. Participants were recruited from the general population. Women included in the study were 18 ± 74 years old and had at least one firstdegree relative with breast cancer by self-report. Focus groups were videotaped and transcribed. Content analysis was performed including independent extraction of themes by 2 authors and confirmation of themes by a third. A computerized software program was used to systematize the process. RESULTS: Two critical domains influencing interest in testing were identified: 1) Selfperceived risk, and 2) Perception of testing as loss or gain of control. Accurate self-perceived risk required an understanding of critical genetic concepts such as sporadic vs. hereditary cancer. Women who categorized themselves as low risk for hereditary cancer had less interest in testing while those who categorized themselves as moderate to high risk were more interested in testing. Women who were interested in testing viewed it as gaining control,``knowing what you're facing,'' and``taking measures to prevent it.'' Women who were not interested in testing were fearful of losing control over their lives, of genetic determinism. Women were able to understand the probabilistic nature of genetic concepts discussed. Paradoxically, understanding that genetic testing would provide probabilities rather than``black and white answers'' made testing more acceptable to some women by allowing them to maintain``a percentage of control'' over their lives. Willingness-to-pay for testing was explored as a proxy for interest in testing. The cost of testing was prohibitive for all but those women who considered themselves at high risk. If cost were not an issue many women would choose to get the test. Concern for genetic discrimination was raised. CONCLUSION: Interest in genetic susceptibility testing for breast cancer is influenced by selfperceived risk and knowledge and beliefs about genetic testing. Comprehension of critical genetic concepts is necessary to accurately assess risk and understand the risks and limitations of testing. Cost and concern for genetic discrimination will affect uptake of testing.