Supporting genetics in primary care: investigating how theory can inform professional education

Abstract

Evidence indicates that many barriers exist to the integration of genetic case finding into primary care. We conducted an exploratory study of the determinants of three specific behaviours related to using breast cancer genetics referral guidelines effectively: ‘taking a family history', ‘making a risk assessment', and ‘making a referral decision'. We developed vignettes of primary care consultations with hypothetical patients, representing a wide range of genetic risk for which different referral decisions would be appropriate. We used the Theory of Planned Behavior to develop a survey instrument to capture data on behavioural intention and its predictors (attitude, subjective norm, and perceived behavioural control) for each of the three behaviours and mailed it to a sample of Canadian family physicians. We used correlation and regression analyses to explore the relationships between predictor and dependent variables. The response rate was 96/125 (77%). The predictor variables explained 38–83% of the variance in intention across the three behaviours. Family physicians' intentions were lower for ‘making a risk assessment' (perceived as the most difficult) than for the other two behaviours. We illustrate how understanding psychological factors salient to behaviour can be used to tailor professional educational interventions; for example, considering the approach of behavioural rehearsal to improve confidence in skills (perceived behavioural control), or vicarious reinforcement as where participants are sceptical that genetics is consistent with their role (subjective norm).

Genetics in primary care: validating a tool to pre‐symptomatically assess common disease risk using an Australian questionnaire on family history

“…A validated questionnaire would mean that taking a family history would be possible within existing time constraints, and registration in EHRs would allow early identification of disease [7]. In addition, Wilson et al [21] reported in 2016 on how repeated family history registration in EHR could support genetics in primary care and how theory informs professional education, writing “We illustrate how understanding psychological factors salient to behaviour can be used to tailor professional educational interventions”. Through exploratory study they found that family physician intentions were lower for “making a risk assessment” because this competency was perceived as more difficult than “taking a family history” and “making a referral decision”.…”

Study protocol: a cluster randomized controlled trial of web-based decision support tools for increasing BRCA1/2 genetic counseling referral in primary care

“…The provider measures that we will evaluate include the following: demographic and professional/practice characteristics, subjective risk communication confidence, [ 62 ] confidence in managing patients with a family history of breast or ovarian cancer, [ 63 ] genetic testing knowledge, [ 64 ] attitudes, [ 65 ] subjective norms, [ 65 ] perceived behavioral control, [ 65 ] behavioral intention, [ 65 ] and orientation towards shared decision making [ 66 ].…”

Perfil de Competência em Genética para Médicos do Brasil: uma Proposta da Sociedade Brasileira de Genética Médica e Genômica

“…Undoubtedly, the integration of genetics into health care requires basic knowledge of common genetic disorders and patterns of hereditariness, prevention measures, genetic tests and treatment innovations. But it also implies skills related to the ability to collect, record and interpret a family history and to non-directive and non-coercive communication, as well as attitudes related to interdisciplinary teamwork, confidentiality of information [68][69][70][71][72] .…”