Referrals of women with a family history of breast cancer from primary care to cancer genetics services in South East Scotland

Campbell, Harry; Holloway, Susan; Cetnarskyj, Roseanne; Anderson, Elaine; Rush, Robert; Fry, Alison; Gorman, Dermot; Steel, Michael; Porteous, Mary

doi:10.1038/sj.bjc.6601348

Cited by 31 publications

(50 citation statements)

References 18 publications

(16 reference statements)

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“…The GPs involved appeared positively disposed towards their patients being seen by specialist genetics nurses, although the standard service was preferred over the community clinic. 124 It is not possible to draw direct conclusions regarding the relative effectiveness of nurse counsellors compared with clinical geneticists from this study, as they were compared in different clinical settings and were not evaluated head to head.…”

Section: Patient Costsmentioning

confidence: 92%

“…108 This may also be explained by nurse practitioners' longer consultation times and the tendency to order more investigations than doctors, both of which are associated with higher levels of patient satisfaction. 114 To date, only one other formal evaluation of nurse counsellors in cancer genetics has been published, [122][123][124][125] with mixed findings. A cluster randomised trial compared the performance of a community clinic for initial risk assessment and counselling, run by specialist genetic nurses, with the standard regional service, which involved a genetics nurse specialist and consultant geneticist.…”

Section: Patient Costsmentioning

confidence: 99%

“…125 The community-based intervention was associated with higher GP referral rates, but no improvement in GP confidence. 124 Further work is required to determine which elements, if any, of an outreach model are likely to lead to which kinds of benefit, and the likely sustainability of different potential configurations of outreach services.…”

Section: Future Research Directionsmentioning

confidence: 99%

See 2 more Smart Citations

Improving the referral process for familial breast cancer genetic counselling: findings of three randomised controlled trials of two interventions

Wilson

Torrance²,

Mollison³

et al. 2005

Health Technol Assess

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Section: Patient Costsmentioning

confidence: 92%

Section: Patient Costsmentioning

confidence: 99%

Section: Future Research Directionsmentioning

confidence: 99%

See 1 more Smart Citation

Improving the referral process for familial breast cancer genetic counselling: findings of three randomised controlled trials of two interventions

Wilson

Torrance²,

Mollison³

et al. 2005

Health Technol Assess

View full text Add to dashboard Cite

show abstract

“…System change interventions included the community provision of specialist services by GPs (n = 9), [108][109][110][111][112][113][114][115][116][117] outreach or community provision by specialists (wholescale provision of a hospital service within the community) (n = 10), [118][119][120][121][122][123][124][125][126][127] return of inappropriate referrals (n = 2), 128,129 the provision of additional primary care staff (n = 3), [130][131][132] the addition or removal of gatekeeping systems (requiring a primary care provider to give access to secondary care services) (n = 4), [133][134][135][136] changes to payment systems (n = 4), [137][138][139] and referral management centre or other major triage systems (n = 6). [140][141][142][143][144][145][146] The overall picture for interventions that aim to implement large system changes to impact on referral is mixed.…”

Section: Box 1 Main Search Strategymentioning

confidence: 99%

Referral interventions from primary to specialist care: a systematic review of international evidence

et al. 2014

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BackgroundDemand management defines any method used to monitor, direct, or regulate patient referrals. Strategies have been developed to manage the referral of patients to secondary care, with interventions that target primary care, specialist services, or infrastructure. AimTo review the international evidence on interventions to manage referral from primary to specialist care. Design and settingSystematic review. MethodIterative, systematic searches of published and unpublished sources public health, health management, management, and grey literature databases from health care and other industries were undertaken to identify recent, relevant studies. A narrative synthesis of the data was completed to structure the evidence into groups of similar interventions. ResultsThe searches generated 8327 unique results, of which 140 studies were included. Interventions were grouped into four intervention categories: GP education (n = 50); process change (n = 49); system change (n = 38); and patient-focused (n = 3). It is clear that there is no 'magic bullet' to managing demand for secondary care services: although some groups of interventions may have greater potential for development, given the existing evidence that they can be effective in specific contexts.

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“…In reality, however, general practitioners (GPs) find this 'gatekeeper' role difficult, both in the UK (Fry et al, 1999;Bankhead et al, 2001;Rose et al, 2001;Walter et al, 2001;Elwyn et al, 2002;Campbell et al, 2003) and elsewhere (Escher and Sappino, 2000). The proportion of referrals to breast cancer family clinics that fall below the required risk threshold has been reported as almost 25% in one large UK-wide survey (Wonderling et al, 2001).…”

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confidence: 99%

Familial breast cancer: management of ‘lower risk’ referrals

et al. 2006

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Up to 40% of referrals from primary care to 'breast cancer family clinics' prove to be of women whose assessed risk falls below the guidelines' threshold for management in secondary or tertiary care, despite recommendations that they should be screened out at primary care level. A randomised trial, involving 87 such women referred to the Tayside Familial Breast Cancer Service compared two ways of communicating risk information, letter or personal interview. Both were found to be acceptable to referred women and to their family doctors, although the former expressed a slight preference for interview. Only four women returned to their family doctors with continuing concerns about breast cancer. Nevertheless, understanding of information provided by either route was unsatisfactory, with apparent confusion about both absolute and relative risks of breast cancer. Substantial minorities appear to believe that they are at no increased risk at all, or even below the population level of risk, while others remain convinced that their personal risk has been underestimated. Family history record forms, completed by the referred women, preferably with the assistance of relatives, are crucial to full assessment of familial risk but one quarter of women referred to the Tayside Familial Breast Cancer Service currently do not complete and return these forms ahead of their clinic appointment. Further collaboration between primary care and the Breast Cancer Family Service is required to improve provision for concerned women whose risks fall below the threshold for special surveillance and to maximise effective use of the family history record form.

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Referrals of women with a family history of breast cancer from primary care to cancer genetics services in South East Scotland

Cited by 31 publications

References 18 publications

Improving the referral process for familial breast cancer genetic counselling: findings of three randomised controlled trials of two interventions

Improving the referral process for familial breast cancer genetic counselling: findings of three randomised controlled trials of two interventions

Referral interventions from primary to specialist care: a systematic review of international evidence

Familial breast cancer: management of ‘lower risk’ referrals

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