Identifying patients with a history of ovarian cancer for referral for genetic counselling: non-randomised comparison of two case-finding strategies in primary care

Abstract

BackgroundRecent guidelines recommend genetic counselling and DNA testing (GCT) for patients with ovarian cancer and survivors of ovarian cancer. Finding survivors of ovarian cancer is challenging. Detecting and referring them for GCT via primary care, to allow proper screening recommendations for patients and their family, may be a solution.AimTo compare the effectiveness and acceptance of two pilot strategies directed at case finding women with a history of ovarian cancer for referral for GCT by their GP.Design and settingNon-randomised comparison of the pilot implementation of two case-finding strategies for women with a history of ovarian cancer in Dutch primary care from May 2016 to April 2017.MethodStrategy A (unsupported) asked GPs to identify and refer eligible patients with a history of ovarian cancer. Strategy B (ICT-supported) provided GPs with information and communication technology (ICT) support to identify patients with a history of ovarian cancer electronically. The effectiveness of each strategy was assessed as the proportion of patients who were approached, referred for GCT, and seen by the clinical geneticist. Acceptance of each strategy was assessed by the intervention uptake of GP practices and GP and patient questionnaires.ResultsNineteen out of 30 (63%) patients identified with a history of ovarian cancer were deemed eligible for referral for strategy A, and 39 out of 94 (41%) for strategy B. For each strategy, eight patients were referred and five (63%) were seen for GCT. The intervention uptake by GP practices was 31% (11 out of 36) for strategy A and 46% (21 out of 46) for strategy B. GPs considered ‘relevance’ and ‘workability’ as facilitators across both strategies whereas, for strategy B, technical barriers hindered implementation.ConclusionThe effectiveness and acceptance of both strategies for case finding of survivors of ovarian cancer in primary care for GCT is promising, but larger studies are required before wide-scale implementation is warranted.

The design, implementation, and effectiveness of intervention strategies aimed at improving genetic referral practices: a systematic review of the literature

“…An additional five studies (17%) also showed improvements, though were not powered for significance [34,39,42,47,58]. Two studies had mixed results (e.g., improvements in some referral outcomes but not others) [3,40,59], while changes in referral rates could not be established in one study due to lack of historical comparator [60]. Five studies (16%) showed no significant improvement in referral [35,38,44,46,61].…”

“…For example, in a study implementing a software program to facilitate assessment of familial cancer risk in general practice, only 14% of the practitioners surveyed had used the program at least once in the one-year study period (potentially explaining the lack of improvement in genetic referral rates) [38]. Clinicians varied in their beliefs about the appropriateness, acceptability and feasibility of interventions, for example clinicians in three studies [3,48,60] found the interventions too time-consuming for day-to-day use. Of the two studies reporting economic outcomes [38,62], these were expressed as marginal costs (e.g., unit costs associated with active intervention components, without reporting of costs to implement).…”