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Oldfield LE, Jones V, Gill B, Kodous N, Fazelzad R, Rodin D, Sandhu H, Umakanthan B, Papadakos J, Giuliani ME. Synthesis of Existent Oncology Curricula for Primary Care Providers: A Scoping Review With a Global Equity Lens. JCO Glob Oncol 2023; 9:e2200298. [PMID: 37141562 DOI: 10.1200/go.22.00298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
PURPOSE Global increases in cancer, coupled with a shortage of cancer specialists, has led to an increasing role for primary care providers (PCP) in cancer care. This review aimed to examine all extant cancer curricula for PCPs and to analyze the motivations for curriculum development. METHODS A comprehensive literature search was conducted from inception to October 13, 2021, with no language restrictions. The initial search yielded 11,162 articles and 10,902 articles underwent title and abstract review. After full-text review, 139 articles were included. Numeric and thematic analyses were conducted and education programs were evaluated using Bloom's taxonomy. RESULTS Most curricula were developed in high-income countries (HICs), with 58% in the United States. Cancer-specific curricula focused on HIC priority cancers, such as skin/melanoma, and did not represent the global cancer burden. Most (80%) curricula were developed for staff physicians and 73% focused on cancer screening. More than half (57%) of programs were delivered in person, with a shift toward online delivery over time. Less than half (46%) of programs were codeveloped with PCPs and 34% did not involve PCPs in the program design and development. Curricula were primarily developed to improve cancer knowledge, and 72 studies assessed multiple outcome measures. No studies included the top two levels of Bloom's taxonomy of learning (evaluating; creating). CONCLUSION To our knowledge, this is the first review to assess the current state of cancer curricula for PCPs with a global focus. This review shows that extant curricula are primarily developed in HICs, do not represent the global cancer burden, and focus on cancer screening. This review lays a foundation to advance the cocreation of curricula that are aligned to the global cancer burden.
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Affiliation(s)
| | - Vivien Jones
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Bhajan Gill
- Cancer Education, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Nardeen Kodous
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Rouhi Fazelzad
- Library and Information Services, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Danielle Rodin
- Royal College of Surgeons in Ireland, Dublin, Ireland
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | - Ben Umakanthan
- Cancer Education, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Janet Papadakos
- Cancer Education, Princess Margaret Cancer Centre, Toronto, ON, Canada
- The Institute for Education Research, University Health Network, Toronto, ON, Canada
| | - Meredith Elana Giuliani
- Cancer Education, Princess Margaret Cancer Centre, Toronto, ON, Canada
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada
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Ong CSB, Fok RW, Tan RCA, Fung SM, Sun S, Ngeow JYY. General practitioners' (GPs) experience, attitudes and needs on clinical genetic services: a systematic review. Fam Med Community Health 2022; 10:fmch-2021-001515. [PMID: 36450397 PMCID: PMC9717000 DOI: 10.1136/fmch-2021-001515] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE The proliferation and growing demands of genetic testing are anticipated to revolutionise medical practice. As gatekeepers of healthcare systems, general practitioners (GPs) are expected to play a critical role in the provision of clinical genetic services. This paper aims to review existing literature on GPs' experience, attitudes and needs towards clinical genetic services. DESIGN A systematic mixed studies review of papers published between 2010 and 2022. ELIGIBILITY CRITERIA The inclusion criterion was peer-reviewed articles in English and related to GPs' experience, views and needs on any genetic testing. INFORMATION SOURCES The PubMed, PsycINFO, Cochrane, EMBASE databases were searched using Mesh terms, Boolean and wildcards combinations to identify peer-reviewed articles published from 2010 to 2022. Study quality was assessed using Mixed Methods Appraisal Tool. Only articles that fulfilled the inclusion criteria were selected. A thematic meta-synthesis was conducted on the final sample of selected articles to identify key themes. RESULTS A total of 62 articles were included in the review. Uncertainty over GPs' role in providing genetic services were attributed by the lack of confidence and time constraints and rarity of cases may further exacerbate their reluctance to shoulder an expanded role in clinical genetics. Although educational interventions were found to increasing GPs' knowledge and confidence to carry out genetic tasks, varied interest on genetic testing and preference for a shared care model with other genetic health professionals have resulted in minimal translation to clinical adoption. CONCLUSION This review highlights the need for deeper exploration of GPs' varied experience and attitudes towards clinical genetic services to better facilitate targeted intervention in the adoption of clinical genetics.
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Affiliation(s)
- Cheryl Siow Bin Ong
- Sociology, School of Social Sciences, Nanyang Technological University, Singapore
| | - Rose Wai‑Yee Fok
- Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Ryo Chee Ann Tan
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Si Ming Fung
- Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Shirley Sun
- Sociology, School of Social Sciences, Nanyang Technological University, Singapore
| | - Joanne Yuen Yie Ngeow
- Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, Singapore,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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Lopez Santibanez Jacome L, Dellefave-Castillo LM, Wicklund CA, Scherr CL, Duquette D, Webster G, Smith ME, Kalke K, Gordon AS, De Berg K, McNally EM, Rasmussen-Torvik LJ. Practitioners' Confidence and Desires for Education in Cardiovascular and Sudden Cardiac Death Genetics. J Am Heart Assoc 2022; 11:e023763. [PMID: 35322684 PMCID: PMC9075463 DOI: 10.1161/jaha.121.023763] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background Educating cardiologists and health care professionals about cardiovascular genetics and genetic testing is essential to improving diagnosis and management of patients with inherited cardiomyopathies and arrhythmias and those at higher risk for sudden cardiac death. The aim of this study was to understand cardiology and electrophysiology practitioners’ current practices, confidence, and knowledge surrounding genetic testing in cardiology and desired topics for an educational program. Methods and Results A one‐time survey was administered through purposive email solicitation to 131 cardiology practitioners in the United States. Of these, 107 self‐identified as nongenetic practitioners. Over three quarters of nongenetic practitioners reported that they refer patients to genetic providers to discuss cardiovascular genetic tests (n=82; 76.6%). More than half of nongenetic practitioners reported that they were not confident about the types of cardiovascular genetic testing available (n=60; 56%) and/or in ordering appropriate cardiovascular genetic tests (n=66; 62%). In addition, 45% (n=22) of nongenetic practitioners did not feel confident making cardiology treatment recommendations based on genetic test results. Among all providers, the most desired topics for an educational program were risk assessment (94%) and management of inherited cardiac conditions based on guidelines (91%). Conclusions This study emphasizes the importance of access to genetics services in the cardiology field and the need for addressing the identified deficit in confidence and knowledge about cardiogenetics and genetic testing among nongenetic providers. Additional research is needed, including more practitioners from underserved areas.
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Affiliation(s)
| | | | - Catherine A Wicklund
- Center for Genetic Medicine Feinberg School of Medicine Northwestern University Chicago IL
| | - Courtney L Scherr
- Department of Communication Studies Northwestern University Chicago IL
| | - Debra Duquette
- Center for Genetic Medicine Feinberg School of Medicine Northwestern University Chicago IL
| | - Gregory Webster
- Department of Pediatrics Ann & Robert H. Lurie Children's Hospital of Chicago Chicago IL
| | - Maureen E Smith
- Center for Genetic Medicine Feinberg School of Medicine Northwestern University Chicago IL
| | - Kerstin Kalke
- Department of Communication Studies Northwestern University Chicago IL
| | - Adam S Gordon
- Center for Genetic Medicine Feinberg School of Medicine Northwestern University Chicago IL
| | | | - Elizabeth M McNally
- Center for Genetic Medicine Feinberg School of Medicine Northwestern University Chicago IL
| | - Laura J Rasmussen-Torvik
- Department of Preventive Medicine Feinberg School of Medicine Northwestern University Chicago IL
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4
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Houwink EJF, Kasteleyn MJ, Alpay L, Pearce C, Butler-Henderson K, Meijer E, van Kampen S, Versluis A, Bonten TN, van Dalfsen JH, van Peet PG, Koster Y, Hierck BP, Jeeninga I, van Luenen S, van der Kleij RMJJ, Chavannes NH, Kramer AWM. SERIES: eHealth in primary care. Part 3: eHealth education in primary care. Eur J Gen Pract 2021; 26:108-118. [PMID: 32757859 PMCID: PMC7470053 DOI: 10.1080/13814788.2020.1797675] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Education is essential to the integration of eHealth into primary care, but eHealth is not yet embedded in medical education. OBJECTIVES In this opinion article, we aim to support organisers of Continuing Professional Development (CPD) and teachers delivering medical vocational training by providing recommendations for eHealth education. First, we describe what is required to help primary care professionals and trainees learn about eHealth. Second, we elaborate on how eHealth education might be provided. DISCUSSION We consider four essential topics. First, an understanding of existing evidence-based eHealth applications and conditions for successful development and implementation. Second, required digital competencies of providers and patients. Third, how eHealth changes patient-provider and provider-provider relationships and finally, understanding the handling of digital data. Educational activities to address these topics include eLearning, blended learning, courses, simulation exercises, real-life practice, supervision and reflection, role modelling and community of practice learning. More specifically, a CanMEDS framework aimed at defining curriculum learning goals can support eHealth education by describing roles and required competencies. Alternatively, Kern's conceptual model can be used to design eHealth training programmes that match the educational needs of the stakeholders using eHealth. CONCLUSION Vocational and CPD training in General Practice needs to build on eHealth capabilities now. We strongly advise the incorporation of eHealth education into vocational training and CPD activities, rather than providing it as a separate single module. How learning goals and activities take shape and how competencies are evaluated clearly requires further practice, evaluation and study.
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Affiliation(s)
- Elisa J F Houwink
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Centre, Leiden, The Netherlands.,National eHealth Living Lab (NELL), Leiden, The Netherlands
| | - Marise J Kasteleyn
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Centre, Leiden, The Netherlands.,National eHealth Living Lab (NELL), Leiden, The Netherlands
| | - Laurence Alpay
- Medical Technology Research Group, Inholland University of Applied Science, Haarlem, The Netherlands
| | - Christopher Pearce
- Centre for Transformation in Digital Health, University of Melbourne, Melbourne, Australia.,Department of General Practice, Monash University, Melbourne, Australia
| | | | - Eline Meijer
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Centre, Leiden, The Netherlands.,National eHealth Living Lab (NELL), Leiden, The Netherlands
| | - Sanne van Kampen
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Centre, Leiden, The Netherlands.,National eHealth Living Lab (NELL), Leiden, The Netherlands
| | - Anke Versluis
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Centre, Leiden, The Netherlands.,National eHealth Living Lab (NELL), Leiden, The Netherlands
| | - Tobias N Bonten
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Centre, Leiden, The Netherlands.,National eHealth Living Lab (NELL), Leiden, The Netherlands
| | - Jens H van Dalfsen
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Centre, Leiden, The Netherlands.,National eHealth Living Lab (NELL), Leiden, The Netherlands
| | - Petra G van Peet
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Centre, Leiden, The Netherlands
| | - Ybranda Koster
- Medical Technology Research Group, Inholland University of Applied Science, Haarlem, The Netherlands
| | - Beerend P Hierck
- Center for Innovation in Medical Education, Leiden University Medical Center, Leiden, The Netherlands.,Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, The Netherlands.,Leiden Teachers' Academy, Leiden University, Leiden, The Netherlands
| | - Ilke Jeeninga
- Center for Innovation in Medical Education, Leiden University Medical Center, Leiden, The Netherlands
| | - Sanne van Luenen
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Centre, Leiden, The Netherlands.,National eHealth Living Lab (NELL), Leiden, The Netherlands
| | - Rianne M J J van der Kleij
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Centre, Leiden, The Netherlands.,National eHealth Living Lab (NELL), Leiden, The Netherlands.,Department of Obstetrics and Gynaecology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Niels H Chavannes
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Centre, Leiden, The Netherlands.,National eHealth Living Lab (NELL), Leiden, The Netherlands
| | - Anneke W M Kramer
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Centre, Leiden, The Netherlands
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Kühn F, Karsten MM, Kendel F, Feufel MA, Speiser D. Training courses on hereditary breast and ovarian cancer to strengthen cross-sectoral care in underserved areas. PATIENT EDUCATION AND COUNSELING 2021; 104:1431-1437. [PMID: 33162275 DOI: 10.1016/j.pec.2020.10.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 10/08/2020] [Accepted: 10/27/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To strengthen cross-sectoral care by disseminating specialized knowledge about hereditary breast and ovarian cancer across underserved areas. METHODS We report on a training course about genetic counseling and testing of hereditary breast and ovarian cancer patients for gynecologists from certified cancer centers. In total, 50 gynecologists attended the course which was offered once annually between 2017 and 2019. Before and after the course, participants were asked to answer a self-assessment questionnaire and completed the training with a multiple-choice test. The results of the self-assessments and knowledge tests were analyzed to steadily improve the training. RESULTS The self-assessments imply a perceived increase in certainty regarding the inclusion criteria for specialized genetic counseling, pedigree analysis, and contents of the initial consultation. Both the knowledge tests and self-assessments showed that participants had difficulties in interpreting and differentiating between age-specific and lifetime risks. CONCLUSION The courses successfully conveyed knowledge necessary to identify patients at risk and to provide timely genetic analyses even in rural areas. PRACTICE IMPLICATIONS The results are a promising basis for creating additional training courses addressing specialists in hospitals and gynecological practices. Further education of physicians might improve cross-sectoral cooperation and thereby enable specialized care supply in rural areas.
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Affiliation(s)
- Friedrich Kühn
- Charité - Universitätsmedizin Berlin, Department of Gynecology, Berlin, Germany
| | | | - Friederike Kendel
- Charité - Universitätsmedizin Berlin, Department of Gender in Medicine, Berlin, Germany
| | - Markus A Feufel
- Technische Universität Berlin, Department of Psychology and Ergonomics (IPA), Division of Ergonomics, Berlin, Germany
| | - Dorothee Speiser
- Charité - Universitätsmedizin Berlin, Department of Gynecology, Berlin, Germany; Charité - Universitätsmedizin Berlin, Hereditary Breast and Ovarian Cancer Center, Berlin, Germany.
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6
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Modernizing family health history: achievable strategies to reduce implementation gaps. J Community Genet 2021; 12:493-496. [PMID: 34028705 DOI: 10.1007/s12687-021-00531-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 05/02/2021] [Indexed: 10/21/2022] Open
Abstract
Family health history (FHH) is a valuable yet underused healthcare tool for assessing health risks for both prevalent disorders like diabetes, cancer, and cardiovascular diseases, and for rare, monogenic disorders. Full implementation of FHH collection and analysis in healthcare could improve both primary and secondary disease prevention for individuals and, through cascade testing, make at risk family members eligible for pre-symptomatic testing and preventative interventions. In addition to risk assessment in the clinic, FHH is increasingly important for interpreting clinical genetic testing results and for research connecting health risks to genomic variation. Despite this value, diverse implementation gaps in clinical settings undermine its potential clinical value and limit the quality of connected health and genomic data. The NHGRI Family Health History Group, an open-membership, US-based group with international members, believes that integrating FHH in healthcare and research is more important than ever, and that achievable implementation advances, including education, are urgently needed to boost the pace of translational utility in genomic medicine. An inventory of implementation gaps and proposed achievable strategies to address them, representing a consensus developed in meetings from 2019-2020, is presented here. The proposed measures are diverse, interdisciplinary, and are guided by experience and ongoing implementation and research efforts.
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Ensuring best practice in genomics education and evaluation: reporting item standards for education and its evaluation in genomics (RISE2 Genomics). Genet Med 2021; 23:1356-1365. [PMID: 33824503 DOI: 10.1038/s41436-021-01140-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 01/19/2023] Open
Abstract
PURPOSE Widespread, quality genomics education for health professionals is required to create a competent genomic workforce. A lack of standards for reporting genomics education and evaluation limits the evidence base for replication and comparison. We therefore undertook a consensus process to develop a recommended minimum set of information to support consistent reporting of design, development, delivery, and evaluation of genomics education interventions. METHODS Draft standards were derived from literature (25 items from 21 publications). Thirty-six international experts were purposively recruited for three rounds of a modified Delphi process to reach consensus on relevance, clarity, comprehensiveness, utility, and design. RESULTS The final standards include 18 items relating to development and delivery of genomics education interventions, 12 relating to evaluation, and 1 on stakeholder engagement. CONCLUSION These Reporting Item Standards for Education and its Evaluation in Genomics (RISE2 Genomics) are intended to be widely applicable across settings and health professions. Their use by those involved in reporting genomics education interventions and evaluation, as well as adoption by journals and policy makers as the expected standard, will support greater transparency, consistency, and comprehensiveness of reporting. Consequently, the genomics education evidence base will be more robust, enabling high-quality education and evaluation across diverse settings.
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Medendorp NM, van den Heuvel LM, Han PKJ, Hillen MA, Smets EMA. Communication skills training for healthcare professionals in providing genetic counseling: A scoping literature review. PATIENT EDUCATION AND COUNSELING 2021; 104:20-32. [PMID: 32782179 DOI: 10.1016/j.pec.2020.07.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 07/07/2020] [Accepted: 07/21/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Genetic counselors need advanced communication skills, particularly when discussing tests involving massively parallel sequencing. Increasingly, non-genetic healthcare professionals (HCPs) also need to provide genetic counseling. Communication skills training (CST) may equip HCPs with the required communication skills. This scoping review provides an overview of the content, approach, effectiveness and effective features of CSTs aimed at improving genetic and non-genetic HCPs' communication skills in providing genetic counseling. METHODS Following the PRISMA-ScR statement, four databases were searched for articles. Two researchers independently screened titles and abstracts, and extracted data. When applicable, information on effectiveness and effective features of CST was collated. RESULTS Twenty-three articles were included. Sixteen CSTs targeted non-genetic HCPs, five targeted genetic HCPs and two targeted both. Most CSTs addressed multiple communication behaviors and consisted of role play. CSTs were found to be effective for improving HCPs (mainly self-reported) attitudes and skills. Limited evidence on specific effective features of CST was found. CONCLUSIONS There is a clear need for evidence on the effectiveness of CST on improving both HCPs' communication skills in the context of genetic counseling, and patient outcomes, and its specific effective features. PRACTICE IMPLICATIONS Clinical practice could benefit from evidence-based CST for genetic and non-genetic HCPs.
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Affiliation(s)
- Niki M Medendorp
- Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Amsterdam, the Netherlands.
| | - Lieke M van den Heuvel
- Department of Clinical Genetics, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Paul K J Han
- Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland, ME, USA
| | - Marij A Hillen
- Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Ellen M A Smets
- Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Amsterdam, the Netherlands; Department of Clinical Genetics, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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Carroll JC, Permaul JA, Semotiuk K, Yung EM, Blaine S, Dicks E, Warner E, Rothenmund H, Esplen MJ, Moineddin R, McLaughlin J. Hereditary colorectal cancer screening: A 10-year longitudinal cohort study following an educational intervention. Prev Med Rep 2020; 20:101189. [PMID: 33117641 PMCID: PMC7581973 DOI: 10.1016/j.pmedr.2020.101189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 07/23/2020] [Accepted: 08/23/2020] [Indexed: 01/08/2023] Open
Abstract
Family history (FH) of a first-degree relative with colorectal cancer (CRC) is associated with two to fourfold increased risk, yet screening uptake is suboptimal despite proven mortality reduction. We developed a FH-based CRC Risk Triage/Management tool for family physicians (FPs), and educational booklet for patients with CRC FH. This report describes physician referral and patient screening behavior 5 and 10 years post-educational intervention, and factors associated with screening. Longitudinal cohort study. FPs/patients in Ontario and Newfoundland, Canada were sent questionnaires at baseline (2005), 5 and 10 years (2015) following tool/booklet receipt. FPs were asked about CRC screening, patients about FH, screening type and timing. "Correct" screening was concordance with tool recommendations. Results reported for 29/121 (24%) FPs and 98/297 (33%) patients who completed all 3 questionnaires. Over 10 years 2/3 patients received the correct CRC screening test at appropriate timing (baseline 75%, 5-year 62%, 10-year 65%). About half reported their FP recommended CRC screening (5-year 51%, 10-year 63%). Fewer than half the patients correctly assessed their CRC risk (44%, 40%, 41%). Patients were less likely to have correct screening timing if female (RR 0.78; 95% CI 0.61, 0.99; p = 0.045). Patients were less likely to have both correct test and timing if moderate/high CRC risk (RR 0.66; 95% CI 0.47, 0.93; p = 0.017) and more likely if their physician recommended screening (RR1.69; 95% CI 1.15, 2.49; p = 0.007). Physician discussion of CRC risk and screening can positively impact patient screening behavior. Efforts are particularly needed for women and patients at moderate/high CRC risk.
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Affiliation(s)
- June C. Carroll
- Ray D. Wolfe Department of Family Medicine, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Joanne A. Permaul
- Ray D. Wolfe Department of Family Medicine, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
| | - Kara Semotiuk
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
| | - Eric M. Yung
- Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada
| | - Sean Blaine
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth Dicks
- Craig L. Dobbin Centre for Genetics Research, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada
| | - Ellen Warner
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Mary Jane Esplen
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Rahim Moineddin
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - John McLaughlin
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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A systematic review of communication interventions to help healthcare professionals discuss genetic testing for breast cancer. Breast Cancer Res Treat 2020; 183:9-21. [PMID: 32577939 PMCID: PMC7376076 DOI: 10.1007/s10549-020-05741-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 06/09/2020] [Indexed: 12/19/2022]
Abstract
Purpose This systematic review examined educational training interventions for healthcare professionals (HCPs) discussing genetic testing and risk for hereditary breast cancer. There was a particular focus on the presence, and content, of communication elements within these packages. Methods Searches were run via CINAHL, EMBASE, PUBMED, and PsychInfo in February 2019 to identify training interventions available to HCPs with reference to communication skills. Studies were assessed for quality, with relevant intervention and outcome data extracted and synthesized. This review followed the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) statement and was registered on the PROSPERO database (CRD42019124010). Results Of 3,988 items, seven papers, two of which were linked, were eligible for inclusion. There was a mix of randomized and single arm studies with web-based and face-to-face interventions. Content included an overview of genetics, hereditary and familial background, and recommended practice techniques. Outcomes focused on communication, self-efficacy, knowledge, and satisfaction. Interventions were designed for genetic counselors, physicians, primary care physicians (PCPs), medical students, and nurses. None of the papers featured oncologists or surgeons. Conclusions This review revealed an overall lack of publications which evaluated interventions to assist HCPs discussing hereditary breast cancer risk and testing. Studies failed to operationalize which ‘communication skills’ they included, nor did they consistently report randomization, outcome measures, or analysis. Discussing the need for, and management of, genetic testing for inherited cancer risk with individuals and their families can be challenging. As genetic testing in breast cancer becomes more common, the provision of specific communication-based training programs, with reference to genetic testing, risk assessments, and counseling skills is warranted. Electronic supplementary material The online version of this article (10.1007/s10549-020-05741-z) contains supplementary material, which is available to authorized users.
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11
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Carroll JC, Allanson J, Morrison S, Miller FA, Wilson BJ, Permaul JA, Telner D. Informing Integration of Genomic Medicine Into Primary Care: An Assessment of Current Practice, Attitudes, and Desired Resources. Front Genet 2019; 10:1189. [PMID: 31824576 PMCID: PMC6882282 DOI: 10.3389/fgene.2019.01189] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 10/28/2019] [Indexed: 01/24/2023] Open
Abstract
Introduction: Preparing primary care providers for genomic medicine (GM) first requires assessment of their educational needs in order to provide clear, purposeful direction and justify educational activities. More understanding is needed about primary care providers’ perspectives on their role in newer areas of GM and what resources would be helpful in practice. Our objective was to determine family physicians’ (FP) current involvement and confidence in GM, attitudes regarding its clinical value, suggestions for integration of GM into practice, and resources and education required. Methods: A self-complete anonymous questionnaire was mailed to a random sample of 2,000 FPs in Ontario, Canada in September 2012. Results: Adjusted response rate was 26% (361/1,365), mean age was 51, and 53% were male. FPs reported many aspects of traditional GM as part of current practice (eliciting family history: 93%; deciding who to refer to genetics: 94%; but few reported confidence (44%, 32% respectively). Newer areas of GM were not part of most FPs’ current practice and confidence was low (pharmacogenetics: 28% part of practice, 5% confident; direct-to-consumer genetic testing: 14%/2%; whole genome sequencing: 8%/2%). Attitudes were mixed with 59% agreeing that GM would improve patient health outcomes, 41% seeing benefits to genetic testing, but only 36% agreeing it was their responsibility to incorporate GM into practice. Few could identify useful sources of genetic information (22%) or find information about genetic tests (21%). Educational resources participants anticipated would be useful included contact information for local genetics clinics (89%), summaries of genetic disorders (86%), and genetic referral (85%) and testing (86%) criteria. About 58% were interested in learning about new genetic technologies. Most (76%) wanted to learn through in-person teaching (lectures, seminars etc.), 66% wanted contact with a local genetic counselor to answer questions, and 59% were interested in a genetics education website. Conclusion: FPs lack confidence in GM skills needed for practice, particularly in emerging areas of GM. They see their role as making appropriate referrals, are somewhat optimistic about the contribution GM may make to patient care, but express caution about its current clinical benefits. There is a need for evidence-based educational resources integrated into primary care and improved communication with genetic specialists.
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Affiliation(s)
- June C Carroll
- Sinai Health System, Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Judith Allanson
- Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Shawna Morrison
- Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Fiona A Miller
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Brenda J Wilson
- Division of Community Health and Humanities, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Joanne A Permaul
- Sinai Health System, Ray D Wolfe Department of Family Medicine, Toronto, ON, Canada
| | - Deanna Telner
- South East Toronto Family Health Team, Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
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12
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Riley VA, Gidlow C, Ellis NJ, Povey RJ, Barnes O, Clark-Carter D. Improving cardiovascular disease risk communication in the UK national health service health check programme. PATIENT EDUCATION AND COUNSELING 2019; 102:2016-2023. [PMID: 31130337 DOI: 10.1016/j.pec.2019.05.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 04/11/2019] [Accepted: 05/14/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To develop and test training to improve practitioners' confidence and perceived understanding when communicating cardiovascular disease (CVD) risk using novel tools and metrics. METHODS A CVD risk communication training workshop was developed through interviews with patients and practitioners delivering Health Checks, a literature review, NICE guidance and the UK Health Check competency framework. It was pilot-tested with practitioners delivering Health Checks in the UK. Perceived practitioner understanding and confidence were measured before and up to 10 weeks after the workshop, and changes were compared with those in a control group (who received no intervention). Perceived impact was also explored through semi-structured interviews. RESULTS Sixty-two practitioners (34 intervention, 28 control) took part. Perceived practitioner understanding (p = .030) and perceived patient understanding (p = .007) improved significantly for those delivering Health Checks in the training group compared with controls. Practitioner confidence also improved significantly more in practitioners who attended the training (p = .001). Findings were supported by interviews with a sub-sample of practitioners (n = 13). CONCLUSION The training workshop improved practitioners' confidence and perceived understanding of CVD risk in Health Checks. PRACTICE IMPLICATIONS The training is an important step to improving practitioner understanding of CVD risk in Health Checks and should be implemented on a wider scale.
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Affiliation(s)
- V A Riley
- Staffordshire University, Leek Road, Stoke-on-Trent, Staffordshire, ST4 2DF, United Kingdom.
| | - C Gidlow
- Staffordshire University, Leek Road, Stoke-on-Trent, Staffordshire, ST4 2DF, United Kingdom.
| | - N J Ellis
- Staffordshire University, Leek Road, Stoke-on-Trent, Staffordshire, ST4 2DF, United Kingdom.
| | - R J Povey
- Staffordshire University, Leek Road, Stoke-on-Trent, Staffordshire, ST4 2DF, United Kingdom.
| | - O Barnes
- Yorkshire & Humber Academic Health Science Network, Navigation Court Calder Park, Wakefield , WF2 7BJ, United Kingdom.
| | - D Clark-Carter
- Staffordshire University, Leek Road, Stoke-on-Trent, Staffordshire, ST4 2DF, United Kingdom.
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13
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Abstract
With rapid advances in genetics and genomics, the commercialization and access to new applications has become more widespread and omnipresent throughout biomedical research. Thus, increasingly, more patients will have personal genomic information they may share with primary care providers (PCPs) to better understand the clinical significance of the data. To be able to respond to patient inquiries about genomic data, variant interpretation, disease risk, and other issues, PCPs will need to be able to increase or refresh their awareness about genetics and genomics, and identify reliable resources to use or refer patients. While provider educational efforts have increased, with the rapid advances in the field, ongoing efforts will be needed to prepare PCPs to manage patient needs, integrate results into care, and refer as indicated.
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Affiliation(s)
- Susanne B Haga
- Center for Applied Genomics and Precision Medicine, Duke University School of Medicine, Durham, NC, 27708, USA.
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14
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Delivering genomic medicine in the United Kingdom National Health Service: a systematic review and narrative synthesis. Genet Med 2019; 21:2667-2675. [PMID: 31186523 DOI: 10.1038/s41436-019-0579-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 05/30/2019] [Indexed: 01/28/2023] Open
Abstract
PURPOSE We sought to assess the readiness of the United Kingdom (UK) National Health Service to implement a Genomic Medicine Service. We conducted a systematic literature review to identify what is known about factors related to the implementation of genomic medicine in routine health care and to draw out the implications for the UK and other settings. METHODS Relevant studies were identified in Web of Science and PubMed from their date of inception to April 2018. The review included primary research studies using quantitative, qualitative, or mixed methods, and systematic reviews. A narrative synthesis was conducted. RESULTS Fifty-five studies met our inclusion criteria. The majority of studies reviewed were conducted in the United States. We identified four domains: (1) systems, (2) training and workforce needs, (3) professional attitudes and values, and (4) the role of patients and the public. CONCLUSION Mainstreaming genomic medicine into routine clinical practice requires actions at each level of the health-care system. Our synthesis emphasized the organizational, social, and cultural implications of reforming practice, highlighting that demonstration of clinical utility and cost-effectiveness, attending to the compatibility of genomic medicine with clinical principles, and involving and engaging patients are key to successful implementation.
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15
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Vande Perre P, Toledano D, Corsini C, Escriba E, Laporte M, Bertet H, Yauy K, Toledano A, Galibert V, Baudry K, Clotet L, Million E, Picot M, Geneviève D, Pujol P. Role of the general practitioner in the care of BRCA1 and BRCA2 mutation carriers: General practitioner and patient perspectives. Mol Genet Genomic Med 2018; 6:957-965. [PMID: 30308700 PMCID: PMC6305637 DOI: 10.1002/mgg3.464] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 07/12/2018] [Accepted: 07/20/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND General practitioners (GPs) have an increasing role in referring patients with putative mutation in BRCA1/2 genes for genetics consultation and for long-term follow-up of mutation carriers. METHODS We compared the expectations of the GPs' role according to BRCA1/2 mutation carriers and to GPs themselves. RESULTS Overall, 38% (58/152) of eligible GPs and 70% (176/252) of eligible patients were surveyed. Although 81% of GPs collected the family history, only 24% considered that they know criteria indicating genetics consultation and 39% sufficient knowledge of BRCA1/2 guidelines to answer patients' questions. Twelve% of GPs were aware of the French national guidelines. Among unsatisfied patients, 40% felt that their GP was able to answer (moderately, sufficiently, or completely) specific questions about BRCA1/2 care as compared with 81% in satisfied patients. Only 33% of GPs reported being informed directly by the geneticist about the patients' results. GPs' main expectations for their role in BRCA1/2 carrier care were psychological support and informing relatives about screening (72% and 71%, respectively), which contrasts with the perceptions of patients, who mainly requested medical advice for BRCA1/2-related care (51%). CONCLUSION There is an important need for GP training and enhancing interactions between GPs and geneticists to improve the GP's role in BRCA1/2 screening and management.
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Affiliation(s)
- Pierre Vande Perre
- Department of Cancer GeneticsMontpellier University Hospital (CHRU)MontpellierFrance
- Université Toulouse III Paul SabatierToulouseFrance
| | - Daniel Toledano
- Department of Cancer GeneticsBreast Disease CenterSaint Louis HospitalParisFrance
| | - Carole Corsini
- Department of Cancer GeneticsMontpellier University Hospital (CHRU)MontpellierFrance
| | - Elsa Escriba
- Department of Cancer GeneticsMontpellier University Hospital (CHRU)MontpellierFrance
| | - Marine Laporte
- Department of Cancer GeneticsMontpellier University Hospital (CHRU)MontpellierFrance
| | - Helena Bertet
- Epidemiology and Clinical Research DepartmentINSERM U1411Clinical Investigation CentreMontpellier University HospitalMontpellierFrance
| | - Kevin Yauy
- Department of GeneticsMontpellier University Hospital (CHRU)MontpellierFrance
- University of MontpellierMontpellierFrance
| | - Alain Toledano
- Department of RadiotherapyHartmann Radiotherapy CenterAmerican Hospital of ParisNeuillyFrance
| | - Virginie Galibert
- Department of Cancer GeneticsMontpellier University Hospital (CHRU)MontpellierFrance
| | - Karen Baudry
- Department of Cancer GeneticsMontpellier University Hospital (CHRU)MontpellierFrance
| | - Lucie Clotet
- University Department of General MedicineUniversity of MontpellierMontpellierFrance
| | - Elodie Million
- University Department of General MedicineUniversity of MontpellierMontpellierFrance
| | - Marie‐Christine Picot
- Department of Medical StatisticsINSERM U1046CNRS UMR 9214University of MontpellierMontpellierFrance
| | - David Geneviève
- Department of GeneticsMontpellier University Hospital (CHRU)MontpellierFrance
- University of MontpellierMontpellierFrance
| | - Pascal Pujol
- Department of Cancer GeneticsMontpellier University Hospital (CHRU)MontpellierFrance
- University of MontpellierMontpellierFrance
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16
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Jackson L, O'Connor A, Paneque M, Curtisova V, Lunt PW, Pourova RK, Macek M, Stefansdottir V, Turchetti D, Campos M, Henneman L, Godino L, Skirton H, Cornel MC. The Gen-Equip Project: evaluation and impact of genetics e-learning resources for primary care in six European languages. Genet Med 2018; 21:718-726. [PMID: 30050101 PMCID: PMC6752302 DOI: 10.1038/s41436-018-0132-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 06/29/2018] [Indexed: 12/04/2022] Open
Abstract
Purpose Genetic advances mean patients at risk of genetic conditions can be helped through testing, clinical screening, and preventive treatment, but they must first be identified to benefit. Ensuring quality of genetic care for patients requires genetic expertise in all health services, including primary care. To address an educational shortfall, a series of e-learning resources was developed in six languages to equip primary care professionals with genetic skills relevant for practice. The purpose of the study was to evaluate these resources using Kirkpatrick’s framework for educational outcomes. Methods Mixed methods (qualitative and quantitative) were used over four phases of the study. Results A high level of satisfaction with the resources was reported. Knowledge and skills improved significantly after using the education material. Participants reported changes in confidence and practice behavior, including family history taking, seeking advice from specialists and referring patients. The resources helped users to learn how to explain genetics. Many visited the resources repeatedly and some used them to educate colleagues or students. Conclusion Gen-Equip modules are effective in improving genetic knowledge, skills, and attitudes for primary care professionals. They provide both continuing professional development and just-in-time learning for a potentially large global audience at a practical level.
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Affiliation(s)
- Leigh Jackson
- Faculty of Health and Human Sciences, Plymouth University, Plymouth, UK.,University of Exeter Medical School, RILD building, Royal Devon and Exeter Hospital, Exeter, United Kingdom
| | - Anita O'Connor
- Faculty of Health and Human Sciences, Plymouth University, Plymouth, UK
| | - Milena Paneque
- i3S Instituto de Investigação e Inovação em Saúde, Institute for Molecular and Cell Biology (IBMC)-Centre for Predictive and Preventive Genetics (CGPP), Universidade do Porto, Porto, Portugal
| | - Vaclava Curtisova
- Dept. of Biology and Medical Genetics, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic.,Palacky University-University Hospital Olomouc, Olomouc, Czech Republic
| | - Peter W Lunt
- Faculty of Health and Human Sciences, Plymouth University, Plymouth, UK
| | - Radka Kremlíková Pourova
- Dept. of Biology and Medical Genetics, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Milan Macek
- Dept. of Biology and Medical Genetics, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | | | - Daniela Turchetti
- Department of Medical and Surgical Sciences, Unit of Medical Genetics, University of Bologna, Bologna, Italy
| | | | - Lidewij Henneman
- Department of Clinical Genetics, Section Community Genetics and Amsterdam Public Health research institute, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
| | - Lea Godino
- UO Oncologia, Policlinico Sant'Orsola Malpighi, Bologna, Italy
| | - Heather Skirton
- Faculty of Health and Human Sciences, Plymouth University, Plymouth, UK
| | - Martina C Cornel
- Department of Clinical Genetics, Section Community Genetics and Amsterdam Public Health research institute, Amsterdam UMC location VUmc, Amsterdam, The Netherlands.
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17
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Ha VTD, Frizzo-Barker J, Chow-White P. Adopting clinical genomics: a systematic review of genomic literacy among physicians in cancer care. BMC Med Genomics 2018; 11:18. [PMID: 29433521 PMCID: PMC5810117 DOI: 10.1186/s12920-018-0337-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 02/05/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This article investigates the genomic knowledge of oncology care physicians in the adoption of clinical genomics. We apply Rogers' knowledge framework from his diffusion of innovation theory to identify three types of knowledge in the process of translation and adoption: awareness, how-to, and principles knowledge. The objectives of this systematic review are to: (1) examine the level of knowledge among physicians in clinical cancer genomics, and (2) identify potential interventions or strategies for development of genomic education for oncology practice. METHODS We follow the PRIMSA statement protocol and conduct a search of five relevant electronic databases. Our review focuses on: (1) genomic knowledge of oncogenomics or genomic services in oncology practices among physicians, and (2) interventions or strategies to provide genomic education of oncogenomics for physicians. RESULTS We include twenty-one studies in our analysis. Nine focus on interventions to provide genomic education for cancer care. Overall, physicians' knowledge of oncogenomics among the three types is limited. The genomic literacy of physicians vary by their provider specialty, location, years of practice, and the type of genomic services. The three distinctions of knowledge offer a sophisticated and helpful tool to design effective strategies and interventions to provide genomic education for cancer treatment. In the nine educational intervention studies, the main intervention outcomes are changes in awareness, referral rates, genomic confidence, and genomic knowledge. CONCLUSION Rogers' diffusion of innovation model allows us to differentiate three types of knowledge in the development and adoption of clinical genomics. This analytical lens can inform potential avenues to design more effective strategies and interventions to provide genomic education for oncology practice. We identified and synthesized a dearth of high quality studies that can inform the most effective educational outcomes of these interventions. Future research should attend to improving applications of genomic services in clinical practices, along with organizational change engendered by genomics in oncology practice.
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Affiliation(s)
- Vu T. Dung Ha
- Simon Fraser University, K8666, Shrum Science Building, 8888 University Drive, Burnaby, BC V5A 1S6 Canada
| | - Julie Frizzo-Barker
- Simon Fraser University, K8666, Shrum Science Building, 8888 University Drive, Burnaby, BC V5A 1S6 Canada
| | - Peter Chow-White
- Simon Fraser University, K8666, Shrum Science Building, 8888 University Drive, Burnaby, BC V5A 1S6 Canada
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18
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Haga SB, Mills R, Moaddeb J, Allen LaPointe N, Cho A, Ginsburg GS. Primary care providers' use of pharmacist support for delivery of pharmacogenetic testing. Pharmacogenomics 2017; 18:359-367. [PMID: 28244812 DOI: 10.2217/pgs-2016-0177] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
AIM To investigate provider utilization of pharmacist support in the delivery of pharmacogenetic testing in a primary care setting. METHODS Two primary care clinics within Duke University Health System participated in the study between December 2012 and July 2013. One clinic was provided with an in-house pharmacist and the second clinic had an on-call pharmacist. RESULTS Providers in the in-house pharmacist arm consulted with the pharmacist for 13 of 15 cases, or about one of every four patients tested compared with one of every 7.5 patients in the on-call pharmacist arm. A total of 63 tests were ordered, 48 by providers in the pharmacist-in-house arm. CONCLUSION These findings suggest that the availability of an in-house pharmacist increases the likelihood of pharmacogenetic test utilization.
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Affiliation(s)
- Susanne B Haga
- Duke Center for Applied Genomics & Precision Medicine, Duke University, Durham, NC, USA
| | - Rachel Mills
- Duke Center for Applied Genomics & Precision Medicine, Duke University, Durham, NC, USA
| | - Jivan Moaddeb
- Duke Center for Applied Genomics & Precision Medicine, Duke University, Durham, NC, USA
| | | | - Alex Cho
- Department of Medicine, Duke University, Durham, NC, USA
| | - Geoffrey S Ginsburg
- Duke Center for Applied Genomics & Precision Medicine, Duke University, Durham, NC, USA
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19
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Schwartz EJ, Issa AM. The role of hospital pharmacists in the adoption and use of pharmacogenomics and precision medicine. Per Med 2017; 14:27-35. [DOI: 10.2217/pme-2016-0063] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Aim: Our aim was to assess the knowledge and attitudes of US hospital pharmacists about the implementation of clinical pharmacogenomics, and examine liability risks of adopting pharmacogenomics by pharmacists. Methods: We surveyed hospital pharmacists. Linear regression models of predictor variables for pharmacist adoption and use of pharmacogenomics were analyzed. Results: The survey was administered to 660 hospital pharmacists (23% response rate; n = 149). The majority of respondents (72%) favor implementing pharmacogenomics into pharmacy practice. However, only 25% are confident in their abilities to interpret pharmacogenomic test results. Conclusion: Pharmacists lack confidence in their abilities to interpret and use pharmacogenomic information in clinical care. These results raise potential liability risks that are pertinent to pharmacists.
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Affiliation(s)
- Emily J Schwartz
- Personalized Medicine & Targeted Therapeutics, University of the Sciences in Philadelphia, 600 S 43rd Street, Philadelphia, PA 19104, USA
| | - Amalia M Issa
- Personalized Medicine & Targeted Therapeutics, University of the Sciences in Philadelphia, 600 S 43rd Street, Philadelphia, PA 19104, USA
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20
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Talwar D, Tseng TS, Foster M, Xu L, Chen LS. Genetics/genomics education for nongenetic health professionals: a systematic literature review. Genet Med 2016; 19:725-732. [PMID: 27763635 DOI: 10.1038/gim.2016.156] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 08/25/2016] [Indexed: 01/03/2023] Open
Abstract
PURPOSE The completion of the Human Genome Project has enhanced avenues for disease prevention, diagnosis, and management. Owing to the shortage of genetic professionals, genetics/genomics training has been provided to nongenetic health professionals for years to establish their genomic competencies. We conducted a systematic literature review to summarize and evaluate the existing genetics/genomics education programs for nongenetic health professionals. METHODS Five electronic databases were searched from January 1990 to June 2016. RESULTS Forty-four studies met our inclusion criteria. There was a growing publication trend. Program participants were mainly physicians and nurses. The curricula, which were most commonly provided face to face, included basic genetics; applied genetics/genomics; ethical, legal, and social implications of genetics/genomics; and/or genomic competencies/recommendations in particular professional fields. Only one-third of the curricula were theory-based. The majority of studies adopted a pre-/post-test design and lacked follow-up data collection. Nearly all studies reported participants' improvements in one or more of the following areas: knowledge, attitudes, skills, intention, self-efficacy, comfort level, and practice. However, most studies did not report participants' age, ethnicity, years of clinical practice, data validity, and data reliability. CONCLUSION Many genetics/genomics education programs for nongenetic health professionals exist. Nevertheless, enhancement in methodological quality is needed to strengthen education initiatives.Genet Med advance online publication 20 October 2016.
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Affiliation(s)
- Divya Talwar
- Department of Health and Kinesiology, Texas A&M University, College Station, Texas, USA
| | - Tung-Sung Tseng
- Department of Behavioral &Community Health Sciences, School of Public Health, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Margaret Foster
- Medical Science Library, Texas A&M University, College Station, Texas, USA
| | - Lei Xu
- Department of Health Education and Promotion, East Carolina University, Greenville, North Carolina, USA
| | - Lei-Shih Chen
- Department of Health and Kinesiology, Texas A&M University, College Station, Texas, USA
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21
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Paneque M, Turchetti D, Jackson L, Lunt P, Houwink E, Skirton H. A systematic review of interventions to provide genetics education for primary care. BMC FAMILY PRACTICE 2016; 17:89. [PMID: 27445117 PMCID: PMC4957387 DOI: 10.1186/s12875-016-0483-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 07/13/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND At least 10 % of patients seen in primary care are said to have a condition in which genetics has an influence. However, patients at risk of genetic disease may not be recognised, while those who seek advice may not be referred or managed appropriately. Primary care practitioners lack knowledge of genetics and genetic testing relevant for daily practice and feel inadequate to deliver genetic services. The aim of this systematic review was to evaluate genetics educational interventions in the context of primary care. METHODS Following the process for systematic reviews developed by the Centre for Reviews and Dissemination, we conducted a search of five relevant electronic databases. Primary research papers were eligible for inclusion if they included data on outcomes of interventions regarding genetics education for primary care practitioners. The results from each paper were coded and grouped under themes. RESULTS Eleven studies were included in the review. The five major themes identified inductively (post hoc) were: prior experience, changes in confidence, changes in knowledge, changes in practice, satisfaction and feedback. In five of the studies, knowledge of practitioners was improved following the educational programmes, but this tended to be in specific topic areas, while practitioner confidence improved in six studies. However, there was little apparent change to practice. CONCLUSIONS There are insufficient studies of relevant quality to inform educational interventions in genetics for primary care practitioners. Educational initiatives should be assessed using changes in practice, as well as in confidence and knowledge, to determine if they are effective in causing significant changes in practice in genetic risk assessment and appropriate management of patients.
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Affiliation(s)
- Milena Paneque
- />i3S Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
- />IBMC – Institute for Molecular and Cell Biology, UnIGENe and Centre for Predictive and Preventive Genetics (CGPP), Universidade do Porto, Porto, Portugal
| | - Daniela Turchetti
- />Department of Medical and Surgical Sciences, Unit of Medical Genetics, University of Bologna, Bologna, Italy
| | - Leigh Jackson
- />Faculty of Health and Human Sciences, Plymouth University, Plymouth, PL4 8AA UK
| | - Peter Lunt
- />Faculty of Health and Human Sciences, Plymouth University, Plymouth, PL4 8AA UK
| | - Elisa Houwink
- />Department of Clinical Genetics, Section Community Genetics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
- />Department of Family Medicine, School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Heather Skirton
- />Faculty of Health and Human Sciences, Plymouth University, Plymouth, PL4 8AA UK
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22
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Reed EK, Johansen Taber KA, Ingram Nissen T, Schott S, Dowling LO, O'Leary JC, Scott JA. What works in genomics education: outcomes of an evidenced-based instructional model for community-based physicians. Genet Med 2015; 18:737-45. [PMID: 26583682 DOI: 10.1038/gim.2015.144] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 09/02/2015] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Education of practicing health professionals is likely to be one factor that will speed appropriate integration of genomics into routine clinical practice. Yet many health professionals, including physicians, find it difficult to keep up with the rapid pace of clinical genomic advances and are often uncomfortable using genomic information in practice. METHODS Having identified the genomics educational needs of physicians in a Silicon Valley-area community hospital, we developed, implemented, and evaluated an educational course entitled Medicine's Future: Genomics for Practicing Doctors. The course structure and approach were based on best practices in adult learning, including interactivity, case-based learning, skill-focused objectives, and sequential monthly modules. RESULTS Approximately 20-30 physicians attended each module. They demonstrated significant gains in genomics knowledge and confidence in practice skills that were sustained throughout and following the course. Six months following the course, the majority of participants reported that they had changed their practice to incorporate skills learned during the course. CONCLUSION We believe the adult-learning principles underlying the development and delivery of Medicine's Future were responsible for participants' outcomes. These principles form a model for the development and delivery of other genomics educational programs for health professionals.Genet Med 18 7, 737-745.
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Affiliation(s)
- E Kate Reed
- National Coalition for Health Professional Education in Genetics, Lutherville, Maryland, USA.,Current affiliation: Department of Clinical and Continuing Education, The Jackson Laboratories, Bar Harbor, Maine, USA (E.K.R., T.I.N., and S.S.); Dowling Associates, San Diego, California, USA (L.O.D.)
| | | | - Therese Ingram Nissen
- National Coalition for Health Professional Education in Genetics, Lutherville, Maryland, USA.,Current affiliation: Department of Clinical and Continuing Education, The Jackson Laboratories, Bar Harbor, Maine, USA (E.K.R., T.I.N., and S.S.); Dowling Associates, San Diego, California, USA (L.O.D.)
| | - Suzanna Schott
- National Coalition for Health Professional Education in Genetics, Lutherville, Maryland, USA.,Current affiliation: Department of Clinical and Continuing Education, The Jackson Laboratories, Bar Harbor, Maine, USA (E.K.R., T.I.N., and S.S.); Dowling Associates, San Diego, California, USA (L.O.D.)
| | - Lynn O Dowling
- Genomic Medicine Institute, El Camino Hospital, Mountain View, California, USA.,Current affiliation: Department of Clinical and Continuing Education, The Jackson Laboratories, Bar Harbor, Maine, USA (E.K.R., T.I.N., and S.S.); Dowling Associates, San Diego, California, USA (L.O.D.)
| | | | - Joan A Scott
- National Coalition for Health Professional Education in Genetics, Lutherville, Maryland, USA
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23
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Haga SB, LaPointe NMA, Cho A, Reed SD, Mills R, Moaddeb J, Ginsburg GS. Pilot study of pharmacist-assisted delivery of pharmacogenetic testing in a primary care setting. Pharmacogenomics 2015; 15:1677-86. [PMID: 25410893 DOI: 10.2217/pgs.14.109] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
AIM To describe the rationale and design of a pilot program to implement and evaluate pharmacogenetic (PGx) testing in a primary care setting. STUDY RATIONALE Several factors have impeded the uptake of PGx testing, including lack of provider knowledge and challenges with operationalizing PGx testing in a clinical practice setting. STUDY DESIGN We plan to compare two strategies for the implementation of PGx testing: a pharmacist-initiated testing arm compared with a physician-initiated PGx testing arm. Providers in both groups will be required to attend an introduction to PGx seminar. Anticipated results: We anticipate that providers in the pharmacist-initiated group will be more likely to order PGx testing than providers in the physician-initiated group. CONCLUSION Overall, we aim to generate data that will inform an effective delivery model for PGx testing and to facilitate a seamless integration of PGx testing in primary care practices.
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Affiliation(s)
- Susanne B Haga
- Duke University Center for Applied Genomics & Precision Medicine, 304 Research Drive, Box 90141 Durham, NC 27708, USA
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24
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Houwink EJF, Muijtjens AMM, van Teeffelen SR, Henneman L, Rethans JJ, Jacobi F, van der Jagt L, Stirbu I, van Luijk SJ, Stumpel CTRM, Meijers-Heijboer HE, van der Vleuten C, Cornel MC, Dinant GJ. Effect of comprehensive oncogenetics training interventions for general practitioners, evaluated at multiple performance levels. PLoS One 2015; 10:e0122648. [PMID: 25837634 PMCID: PMC4383330 DOI: 10.1371/journal.pone.0122648] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 02/11/2015] [Indexed: 11/19/2022] Open
Abstract
General practitioners (GPs) are increasingly called upon to identify patients at risk for hereditary cancers, and their genetic competencies need to be enhanced. This article gives an overview of a research project on how to build effective educational modules on genetics, assessed by randomized controlled trials (RCTs), reflecting the prioritized educational needs of primary care physicians. It also reports on an ongoing study to investigate long-term increase in genetic consultation skills (1-year follow-up) and interest in and satisfaction with a supportive website on genetics among GPs. Three oncogenetics modules were developed: an online Continuing Professional Development (G-eCPD) module, a live genetic CPD module, and a "GP and genetics" website (huisartsengenetica.nl) providing further genetics information applicable in daily practice. Three assessments to evaluate the effectiveness (1-year follow-up) of the oncogenetic modules were designed: 1.An online questionnaire on self-reported genetic competencies and changes in referral behaviour, 2.Referral rates from GPs to clinical genetics centres and 3.Satisfaction questionnaire and visitor count analytics of supportive genetics website. The setting was Primary care in the Netherlands and three groups of study participants were included in the reported studies:. Assessment 1. 168 GPs responded to an email invitation and were randomly assigned to an intervention or control group, evaluating the G-eCPD module (n = 80) or the live module (n = 88). Assessment 2. Referral rates by GPs were requested from the clinical genetics centres, in the northern and southern parts of the Netherlands (Amsterdam and Maastricht), for the two years before (2010 [n = 2510] and 2011 [n = 2940]) and the year after (2012 [n = 2875]) launch of the oncogenetics CPD modules and the website. Assessment 3. Participants of the website evaluation were all recruited online. When they visited the website during the month of February 2013, a pop-up invitation came up. Of the 1350 unique visitors that month, only 38 completed the online questionnaire. Main outcomes measure showed long-term (self-reported) genetic consultation skills (i.e. increased genetics awareness and referrals to clinical genetics centres) among GPs who participated in the oncogenetic training course, and interest in and satisfaction with the supportive website. 42 GPs (52%) who previously participated in the G-eCPD evaluation study and 50 GPs (57%) who participated in the live training programme responded to the online questionnaire on long-term effects of educational outcome. Previous RCTs showed that the genetics CPD modules achieved sustained improvement of oncogenetic knowledge and consultation skills (3-months follow-up). Participants of these RCTs reported being more aware of genetic problems long term; this was reported by 29 GPs (69%) and 46 GPs (92%) participating in the G-eCPD and live module evaluation studies, respectively (Chisquare test, p<0.005). One year later, 68% of the respondents attending the live training reported that they more frequently referred patients to the clinical genetics centres, compared to 29% of those who attended the online oncogenetics training (Chisquare test, p<0.0005). However, the clinical genetics centres reported no significant change in referral numbers one year after the training. Website visitor numbers increased, as did satisfaction, reflected in a 7.7 and 8.1 (out of 10) global rating of the website (by G-eCPD and live module participants, respectively). The page most often consulted was "family tree drawing". Self-perceived genetic consultation skills increased long-term and GPs were interested in and satisfied with the supportive website. Further studies are necessary to see whether the oncogenetics CPD modules result in more efficient referral. The results presented suggest we have provided a flexible and effective framework to meet the need for effective educational programmes for non-geneticist healthcare providers, enabling improvement of genetic medical care.
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Affiliation(s)
- Elisa J. F. Houwink
- Department of Clinical Genetics, Section Community Genetics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
- School for Public Health and Primary Care, Department of Family Medicine, Maastricht University, Maastricht, The Netherlands
- * E-mail:
| | - Arno M. M. Muijtjens
- Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Sarah R. van Teeffelen
- Department of Clinical Genetics, Section Community Genetics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Lidewij Henneman
- Department of Clinical Genetics, Section Community Genetics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Jan Joost Rethans
- Skillslab, Faculty of Health, Medicine & Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Florijn Jacobi
- Dutch College of General practitioners (NHG), Utrecht, The Netherlands
| | | | - Irina Stirbu
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Scheltus J. van Luijk
- Department of Resident Training, Maastricht University Medical Centre +, Maastricht, The Netherlands
| | - Connie T. R. M. Stumpel
- Department of Clinical Genetics, School for Oncology and Developmental Biology, Maastricht UMC+, Maastricht, The Netherlands
| | | | - Cees van der Vleuten
- Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Martina C. Cornel
- Department of Clinical Genetics, Section Community Genetics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Geert Jan Dinant
- School for Public Health and Primary Care, Department of Family Medicine, Maastricht University, Maastricht, The Netherlands
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25
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Carroll JC, Blaine S, Permaul J, Dicks E, Warner E, Esplen MJ, Rothenmund H, Semotiuk K, Worrall G, McLaughlin J. Efficacy of an educational intervention on family physicians' risk assessment and management of colorectal cancer. J Community Genet 2014; 5:303-11. [PMID: 24715212 DOI: 10.1007/s12687-014-0185-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 03/10/2014] [Indexed: 12/31/2022] Open
Abstract
We developed a point-of-care tool indicating risk categories for colorectal cancer (CRC) based on family history (FH) and management recommendations tailored to risk. The study objective was to determine if this CRC Risk Triage/Management Too would enable family physicians (FPs) to appropriately triage and make screening and genetics referral recommendations for patients with CRC FH. Baseline questionnaires were mailed to a random sample of FPs in Ontario and Newfoundland, Canada. Participants were asked to use the tool for 3 months and then complete a follow-up questionnaire. The primary outcomes were correct responses to questions regarding CRC risk category, screening method, starting age, frequency, and decision to refer to genetics, for eight clinical vignettes. The study was completed by 75/121 (62 %) participating FPs. Most (77 %) agreed they routinely recommended fecal occult blood testing for average risk patients age ≥50. This did not change significantly following the intervention. There was a significant increase in confidence in CRC risk assessment (52 % pre; 88 % post; p < 0.001), correct management recommendations for patients with CRC FH (51 % pre; 84 % post; p < 0.001), and improvement in total mean scores on outcome measures for all vignettes. Most (90 %) agreed the tool would improve practice. Receipt of the CRC Risk Triage/Management Tool was associated with improvement in FPs' CRC risk assessment, screening, and genetics referral recommendations for clinical vignettes. This demonstrates the value of point-of-care tools and illustrates a process for development, evaluation, and dissemination of tools needed by FPs if potential impacts of genomic advances are to be achieved.
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Affiliation(s)
- J C Carroll
- Department of Family and Community Medicine, Mount Sinai Hospital, University of Toronto, 60 Murray St., Toronto, ON, M5T 3L9, Canada,
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