The impact of the number of tests presented and a provider recommendation on decisions about genetic testing for cancer risk

•Patients presented with more genetic testing options are more likely to select genetic testing.•Most individuals can make a preference-consistent choice based on a genetic test description.•A provider recommendation can impact choices inconsistent with stated preferences. To determine how the method of presenting testing options and a provider recommendation can influence a decision about genetic testing for inherited cancer predispositions. An online hypothetical vignette study was completed by 454 healthy volunteers. Participants were randomized to receive one of two survey versions which differed by genetic testing choice presentation. One group was shown three options simultaneously (no test, 5-gene or 15-gene), and a second group received the 15-gene option after choosing between the no test and 5-gene options. A preference-based provider recommendation was also incorporated. We examined the effect of these interventions on test selection. Participants in the simultaneous group were more likely to choose a genetic test than those in the sequential group (OR: 2.35, p=0.003). This effect was no longer observed when individuals who had selected no-test in the sequential group were told about the 15-gene test (OR: 1.03 p=0.932). Incorporating a provider recommendation into the hypothetical scenario led to more preference-consistent choices (χ2 = 8.53, p < 0.0035,). A larger menu of testing choices led to higher testing uptake. A preference-based clinician recommendation resulted in more preference-consistent choices. The structuring of testing options and preference-sensitive recommendations appear to facilitate informed testing decisions.