The GRAIDS Trial: a cluster randomised controlled trial of computer decision support for the management of familial cancer risk in primary care

Emery, Jon; Morris, Helen; Goodchild, Robin; Fanshawe, Thomas R; Prevost, A. Toby; Bobrow, Martin; Kinmonth, Ann Louise

doi:10.1038/sj.bjc.6603897

Cited by 92 publications

(114 citation statements)

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“…13 Studies in the United Kingdom have shown that referral guidelines and computerized decision support for general practitioners around familial risk assessment have facilitated appropriate referrals for genetic testing and improved clinician satisfaction with their ability to identify patients for genetic testing and manage familiar cancer risk. [30][31][32] A shortage of adult medical geneticists is another problem that has been reported. 27,33 Our study has important clinical and policy implications.…”

Section: Discussionmentioning

confidence: 99%

“…2 Computerized tools that collect family history data and utilize clinical decision support to help physicians evaluate risk, provide tailored prevention messages, and make appropriate referrals may be particularly useful. 4,6,31,35,36 A major strength of our study is the use of a large, nationally representative dataset. The 2005 NHIS collected detailed information on family history of cancer, including both number of first-degree relatives and age of onset, allowing us to examine strength of familial risk in relation to awareness, referral, and use of genetic testing.…”

Section: Discussionmentioning

confidence: 99%

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Familial Risk of Cancer and Knowledge and Use of Genetic Testing

et al. 2010

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BACKGROUND: Identification of genetic risk factors for common diseases, including cancer, highlights the importance of familial risk assessment. Little is known about patterns of familial cancer risk in the general population, or whether this risk is associated with knowledge and use of genetic testing. OBJECTIVE: To examine the distribution of familial cancer risk and its associations with genetic testing in the United States. DESIGN: Cross-sectional analysis of the 2005 National Health Interview Survey (NHIS). PARTICIPANTS: 31,428 adults who completed the NHIS Cancer Control Supplement. MAIN MEASURES: Familial cancer risk was estimated based on the number of first-degree relatives with a breast and ovarian cancer syndrome (BRCA)-or a Lynchassociated cancer, age of onset (<50 or ≥50 years), and personal history of any cancer. Outcomes included having heard of genetic testing, discussed genetic testing with a physician, been advised by a physician to have testing, and received genetic testing. KEY RESULTS: Most adults (84.5%) had no family history of BRCA-or Lynch syndrome-associated cancer; 12.9% had a single first-degree relative (5.3% with early onset); and 2.7% had ≥2 first-degree relatives. Although 40.2% of adults had heard of genetic testing for cancer risk, only 5.6% of these individuals had discussed testing with a physician, and of these 36.9% were advised to be tested. Overall, only 1.4% of adults who had heard of genetic testing received a test. Familial risk was associated with higher rates of testing; 49.5% of participants in the highest risk group had heard of testing, of those 14.8% had discussed it with their physician, and 4.5% had received genetic testing. CONCLUSIONS: These nationally representative data provide estimates of the prevalence of familial cancer risk in the US and suggest that information about genetic testing is not reaching many at higher risk of inherited cancer.KEY WORDS: family history; primary care practice; cancer.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Familial Risk of Cancer and Knowledge and Use of Genetic Testing

et al. 2010

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“…The emerging model can be supported by information technology and software applications assisting in genetic risk assessment 4,5 or by embedding genetic nurse coordinators or genetic counselors within clinics. 6,7 The traditional model of multidisciplinary specialist clinics is generally organized as a regional genetic center, usually affiliated with an academic medical center, offering clinics for various patient-care needs (e.g., prenatal, cancer genetic, and pediatric genetic needs).…”

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confidence: 99%

Delivery of clinical genetic consultative services in the Veterans Health Administration

Scheuner

Marshall

Lanto

et al. 2014

Genetics in Medicine

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Original research articleIntegration of genetic information into health care can improve health outcomes through improved diagnosis, risk assessment, prognosis, and treatment decisions. However, to fully realize the benefits of genetic information, it will be important to identify successful models of care, 1 particularly for the field of adult genetics, which is growing due to increasing recognition of adults with genetic conditions and expanding genetic testing opportunities for adult-onset conditions. 2 Delivery models for genetic consultative services were recently described in a systematic review of genetics in health 3 ; they include (i) the traditional model of multidisciplinary specialist clinics or coordinated services between geneticists and other specialists-the latter is favored for adult-onset conditions-and (ii) the emerging model, in which genetic services are integrated directly within primary care and other specialties. The emerging model can be supported by information technology and software applications assisting in genetic risk assessment 4,5 or by embedding genetic nurse coordinators or genetic counselors within clinics. 6,7 The traditional model of multidisciplinary specialist clinics is generally organized as a regional genetic center, usually affiliated with an academic medical center, offering clinics for various patient-care needs (e.g., prenatal, cancer genetic, and pediatric genetic needs).3 These regional centers can provide expertise to smaller genetics clinics in the community, like a hub-and-spoke network.3 This can be achieved by the core (hub) facility accepting referrals from the peripheral clinics (spokes) or through the use of (i) "telegenetics, " which brings core genetic services into peripheral clinics via videoteleconferencing, 8,9 and (ii) telephone genetic consultation, which provides core genetic services directly to patients. 10,11The health professionals providing clinical genetic consultative services are genetic specialists (medical geneticists, genetic counselors, and nurse geneticists) or non-genetics health-care professionals who are increasingly using genetics in routine care, including primary-care providers, other specialists, nurses, psychologists, and social workers. 3 The lack of medical geneticists has been recognized as a serious problem Objective: To characterize the delivery of genetic consultative services for adults, we examined the prevalence and organizational determinants of genetic consult availability and the organization of these services in the Veterans Health Administration. Methods:We conducted a Web-based survey of Veterans Health Administration clinical leaders. We summarized facility characteristics using descriptive statistics. Multivariate logistic regression assessed associations between organizational characteristics and consult availability. Results:We received 353 survey responses from key informants representing 141 Veterans Affairs Medical Centers. Clinicians could obtain genetic consults at 110 (78%) Veterans Affairs Medical Cen...

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“…Computer aided decision making is used to improve the quality of diagnose and treatment. Emery et al 5 report an assessment strategy on British general practice familial cancer risk managing using the computer decision support system. They also reveal a computerized decision support system Risk Assessment in Genetics 6 .…”

Section: Discussionmentioning

confidence: 99%

Abstracts of the Medical Engineering and Bioinformatics 2015 (MEB 2015), China, 7 June 2015

2015

Basic Clin Pharma Tox

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Aims: The laparoscopy reduces the damage to body and shortens the postoperative recovery period, so it is becoming the standard surgical operation. However, the indirect method of observing and manipulating in laparoscopy impairs the surgeon's eye-hand coordination, which makes it difficult to carry out a laparoscopic operation successfully. Then we initiate the optical see-through technique in order to find solutions for these difficulties of laparoscopy. Methods: The floating display mechanism of optical see-through technique is proposed and deeply researched to overcome the mislocation of camera picture and the misorientation of instrument movements. The line-of-sight of endoscope is transformed and coincides with the surgeon's natural line-of-sight. The pictures of endoscope are projected onto the semi-transparent mirror between the surgeon's eyes and the abdomen, and the pre-operative information from X-ray, ultrasound or MRI images are also mapped onto the endoscope camera pictures, which gives the surgeon the visual sense of seeing through the skin. An experimental optical see-through system is constructed. Results: Extensive experiments are conducted on phantoms to verify the accuracy and stability of the constructed system. Experimental results show that the optical see-through system has better performance and overcomes the eye-hand coordination problem. Conclusions:The optical see-through system shows its superiority in laparoscopy, and has a broad application prospect in the future. We will develop its new functions for other kinds of surgeries such as arthroscopy. Its disadvantages such as complex calibration procedure have to be resolved in the future. College of Information System and Management, National University of Defense Technology, Changsha, Hunan, China Aims: One ubiquitous limitation of most previous studies in Health Monitoring Systems is they just focused on the architecture but disregard the acquired data. This manuscript try to obtain better monitor effect though an improved Statistical Process Control (SPC) control chart. Methods: Two groups of volunteers participated in the questionnaire. They had diabete or hypertension separately, and their living habits and environments were similar. Under the control of Minimum Mean Squared Error (MMSE), we can eliminate the influence of autocorrelation and cyclical change. The system would send timely warning signs by inputting the convert white noises to the Cumulative Sum (CUSUM) and Exponentially Weighted Moving-Average (EWMA) control chart. Results: Since the introduction of CUSUM and EWMA control chart, the system could detect the tiny changes of cumulating trend. In addition, it becomes more sensitive after the utilization of a positive feedback when the correlation of data is high. Conclusions: The system presented in this article bring better results, as the ability to get change of accumulation has more practical value in keeping healthy. The number of cases was inadequate, however, the correctness and validity of the improved method h...

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The GRAIDS Trial: a cluster randomised controlled trial of computer decision support for the management of familial cancer risk in primary care

Cited by 92 publications

References 30 publications

Familial Risk of Cancer and Knowledge and Use of Genetic Testing

Familial Risk of Cancer and Knowledge and Use of Genetic Testing

Delivery of clinical genetic consultative services in the Veterans Health Administration

Abstracts of the Medical Engineering and Bioinformatics 2015 (MEB 2015), China, 7 June 2015

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