The Impact of Genetic Outreach Education and Support to Primary Care on Practitioner’s Confidence and Competence in Dealing with Familial Cancers

Abstract

Aims: To determine the level of competence and confidence in general practice in relation to the management of familial cancers and to determine the impact of providing genetic educational outreach on confidence and competence. Methods: Confidence and competence in dealing with familial cancers was measured using a postal questionnaire sent to all general practitioners and practice nurses in 4 geographical areas in central England. In 2 areas, genetic educational outreach was provided to 10 randomly selected practices and a matched analysis of questionnaire responses before and after intervention was done to determine the impact of the intervention. Results: Respondents were more confident in dealing with patient queries around familial breast cancer risk than those around bowel cancer. This was inconsistent with the ability to correctly assign familial risk, with 48% incorrectly assigning a high-risk categorisation to a low-risk breast cancer scenario. Respondents who had taken part in the intervention reported more confidence in dealing with issues related to the management of patient queries around bowel cancer. Following intervention, participants were more likely to report feeling confident in knowing the relevant family history to collect (72.4% of respondents from participating practices compared to 56.1% from non-participating practices; OR 2.39, p = 0.02, 95% CI 1.14–5.00) and in making a basic assessment of risk (72.4% compared to 38.9%; OR 3.65, p = 0.01, 95% CI 1.38–9.61). Conclusions: Providing genetic educational outreach has a positive impact upon how confident primary care staff feel in dealing with patient queries over familial cancers, particularly in relation to bowel cancer. Further research is needed to explore the impact of providing this service on other relevant outcomes such as appropriateness of referrals to genetic services.

What hinders minority ethnic access to cancer genetics services and what may help?

“…Providers in primary care 56 and the range of physicians or surgeons in cancer care 57 may feel they lack adequate genetic knowledge or skills in this area. This, and challenges of communication, including language barriers, may be one reason those from ethnic minorities appear less likely to be referred to cancer genetics services.…”

Educational needs about cancer family history and genetic counseling for cancer risk among frontline healthcare clinicians in New York City

“…However, a recent study found that primary care physicians’ ability to correctly assign risk was low, even in cases where they reported high levels of confidence in their ability to assign risk; specifically, half of primary care physicians incorrectly assigned a high-risk categorization to a low-risk case. 25 In another study using unannounced standardized (simulated) patients, satisfaction with physician communication was higher for moderate risk cases compared with high-risk case, 26 highlighting that many physicians are unprepared to address complex high-risk scenarios. Results suggest that educational training programs designed for frontline healthcare clinicians should focus on increasing the ability of clinicians to correctly identify risk level and make appropriate risk management recommendations (surveillance, screening, and referral for counseling).…”

Survey on Knowledge, Attitudes, and Training Needs of Italian Residents on Genetic Tests for Hereditary Breast and Colorectal Cancer

“…Recent research showed that providing genetic educational outreach to doctors has a positive impact in improving their competency and confidence in the use of genetic testing to guide prevention or treatment decisions [6–8]. Although the importance of genomic education for health care professionals has been recognized even before completion of the Human Genome Project [9], many physicians do not feel to have a proper training and knowledge [3, 4].…”