Factors influencing the referrals in primary care of asymptomatic patients with a family history of cancer

Abstract

Referral guidelines that are practicable in the context of a busy primary care clinic need to be developed if primary care practitioners are to play the major role desired for them in genetics.

Primary-care providers’ perceived barriers to integration of genetics services: a systematic review of the literature

“…The most commonly cited barrier category within this theme was a general lack of genetic knowledge (n = 24 cited in 20/38 studies); this included specific barriers around PCPs' self-reported lack of confidence in their own knowledge about genetics in general (n = 7) 6-12 and about clinical genetics, 13 an interest in gaining insight regarding the genetic background of a disease, 14 and a lack of confidence in their ability to perform core competencies such as taking an FH, 15 including a lack of knowledge about what FH information to collect. 16 Among the several skill-related barriers identified, the most commonly cited (n = 16 citations in 16/38 studies) was a lack of confidence their ability to counsel patients about genetic risk and to manage them. Specifically, providers expressed concerns about feeling unqualified to provide genetic counseling to patients and making the correct management decisions.…”

“…PCPs reported that it was hard to keep up to date with evidence, specifically updated and revised professional guidelines (n = 9, citations of barrier in 9/38 studies). 16,21,[25][26][27][28][29][30] A lack of access to current information about genetics and being unaware of existing educational resources were also identified as barriers. 10,12,25,31 When general practitioners in Australia were asked to nominate resources that would be valuable to them, they requested point-of-care resources to guide risk assessment.…”

“…4,9,10,28,30 In addition, PCPs reported having insufficient tools to assess cancer risk and that it was difficult to enter FH information into the electronic health record. 14,31 PCPs reported that their patients' accuracy when providing FH information was a barrier, 16,21,27,28 as were language and culture barriers when discussing FH and genetics with patients. 14,21,22,27 Evidence A total of nine barriers related to current scientific evidence behind use of genetics services were identified in the studies (Supplementary Figure S4 online); the most commonly cited barrier was a perceived lack of therapeutic interventions available after the identification of increased risk (n = 11 cited in 11/38 studies) 24,27,28,36,39 and the notion that patient management would not change as a result of genetic assessment.…”

Breast cancer genetic counselling referrals: how comparable are the findings between the UK and the Netherlands?

“…Additionally, British GPs have been found to adopt a reactive rather than proactive role in the referral of asymptomatic patients with a family history of cancer (Al Habsi et al 2008). Our findings suggest that less-educated British counselees raise the cause of concern for hereditary breast cancer more often than their Dutch counterparts and this might explain the genetic counselling uptake of a more educationally diverse group in the WM.…”

“…Studies of GP genetics knowledge show they have poor knowledge and that breast cancer genetics education (Watson et al 2002;Bethea et al 2008) and communication of referral guidelines could indeed improve GPs' management of familial breast cancer. The lower percentage of counselees at population risk might indicate that UK GPs prefer to refer patients to a cancer diagnostic clinic (Al Habsi et al 2008) or more often reassure population-risk individuals, without referring them for breast cancer genetic counselling. This would be in accordance with the NICE guideline recommending that low-risk individuals are dealt within primary care and moderate-risk individuals in cancer units (NICE 2006).…”