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Qureshi N, Dutton B, Weng S, Sheehan C, Chorley W, Robertson JFR, Kendrick D, Kai J. Improving primary care identification of familial breast cancer risk using proactive invitation and decision support. Fam Cancer 2020; 20:13-21. [PMID: 32524330 PMCID: PMC7870768 DOI: 10.1007/s10689-020-00188-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 05/18/2020] [Indexed: 01/28/2023]
Abstract
Family history of breast cancer is a key risk factor, accounting for up to 10% of cancers. We evaluated the proactive assessment of familial breast cancer (FBC) risk in primary care. Eligible women (30 to 60 years) were recruited from eight English general practices. Practices were trained on FBC risk assessment. In four randomly-assigned practices, women were invited to complete a validated, postal family history questionnaire, which practice staff inputted into decision support software to determine cancer risk. Those with increased risk were offered specialist referral. Usual care was observed in the other four practices. In intervention practices, 1127/7012 women (16.1%) returned family history questionnaires, comprising 1105 (98%) self-reported white ethnicity and 446 (39.6%) educated to University undergraduate or equivalent qualification, with 119 (10.6%) identified at increased breast cancer risk and offered referral. Sixty-seven (56%) women recommended referral were less than 50 years old. From 66 women attending specialists, 26 (39.4%) were confirmed to have high risk and recommended annual surveillance (40–60 years) and surgical prevention; while 30 (45.5%) were confirmed at moderate risk, with 19 offered annual surveillance (40–50 years). The remaining 10 (15.2%) managed in primary care. None were recommended chemoprevention. In usual care practices, only ten women consulted with concerns about breast cancer family history. This study demonstrated proactive risk assessment in primary care enables accurate identification of women, including many younger women, at increased risk of breast cancer. To improve generalisability across the population, more active methods of engagement need to be explored. Trial registration: CRUK Clinical Trials Database 11779.
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Affiliation(s)
- Nadeem Qureshi
- Division of Primary Care, NIHR School for Primary Care Research, School of Medicine, University of Nottingham, 13th Floor, Tower Building, Nottingham, NG7 2RD, UK.
| | - Brittany Dutton
- Division of Primary Care, NIHR School for Primary Care Research, School of Medicine, University of Nottingham, 13th Floor, Tower Building, Nottingham, NG7 2RD, UK
| | - Stephen Weng
- Division of Primary Care, NIHR School for Primary Care Research, School of Medicine, University of Nottingham, 13th Floor, Tower Building, Nottingham, NG7 2RD, UK
| | - Christina Sheehan
- Division of Primary Care, NIHR School for Primary Care Research, School of Medicine, University of Nottingham, 13th Floor, Tower Building, Nottingham, NG7 2RD, UK
| | - Wendy Chorley
- University Hospitals Derby & Burton NHS Foundation Trust, Royal Derby Hospital, Derby, UK
| | | | - Denise Kendrick
- Division of Primary Care, NIHR School for Primary Care Research, School of Medicine, University of Nottingham, 13th Floor, Tower Building, Nottingham, NG7 2RD, UK
| | - Joe Kai
- Division of Primary Care, NIHR School for Primary Care Research, School of Medicine, University of Nottingham, 13th Floor, Tower Building, Nottingham, NG7 2RD, UK
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Smeets HM, Kortekaas MF, Rutten FH, Bots ML, van der Kraan W, Daggelders G, Smits-Pelser H, Helsper CW, Hoes AW, de Wit NJ. Routine primary care data for scientific research, quality of care programs and educational purposes: the Julius General Practitioners' Network (JGPN). BMC Health Serv Res 2018; 18:735. [PMID: 30253760 PMCID: PMC6156960 DOI: 10.1186/s12913-018-3528-5] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 09/07/2018] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND General Practitioners (GPs) in the Netherlands routinely register all patient contacts electronically. These records include longitudinally gathered clinical information of the patient contacts in coded data and free text. METHODS Diagnoses are coded according to the International Coding of Primary Care (ICPC). Drug prescriptions are labelled with the Anatomical Therapeutic Chemical Classification (ATC), and letters of hospital specialists and paramedic health care professionals are linked or directly incorporated in the electronic medical files. A network of a large group of GPs collecting routine care data on an ongoing basis can be used for answering various research questions. RESULTS The Julius General Practitioners' Network (JGPN) database consists of routine care data from over ten years of a dynamic cohort of around 370,000 individuals registered with the participating GPs from the city of Utrecht and its vicinity. Health care data are extracted anonymously every quartile of a year and these data are used by researchers. CONCLUSION We describe the content and usability of our JGPN database, and how a wide variety of research questions could be answered, as illustrated with examples of published articles.
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Affiliation(s)
- Hugo M Smeets
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, P.O. Box 85500, 3508, GA, Utrecht, The Netherlands
| | - Marlous F Kortekaas
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, P.O. Box 85500, 3508, GA, Utrecht, The Netherlands.
| | - Frans H Rutten
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, P.O. Box 85500, 3508, GA, Utrecht, The Netherlands.,General practice De Grebbe, Rhenen, The Netherlands
| | - Michiel L Bots
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, P.O. Box 85500, 3508, GA, Utrecht, The Netherlands
| | | | | | | | - Charles W Helsper
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, P.O. Box 85500, 3508, GA, Utrecht, The Netherlands
| | - Arno W Hoes
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, P.O. Box 85500, 3508, GA, Utrecht, The Netherlands
| | - Niek J de Wit
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, P.O. Box 85500, 3508, GA, Utrecht, The Netherlands.,General practice Health Centres Leidsche Rijn, Utrecht, The Netherlands
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van der Giessen JAM, van Riel E, Velthuizen ME, van Dulmen AM, Ausems MGEM. Referral to cancer genetic counseling: do migrant status and patients' educational background matter? J Community Genet 2017; 8:303-310. [PMID: 28868568 PMCID: PMC5614888 DOI: 10.1007/s12687-017-0326-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 08/21/2017] [Indexed: 12/17/2022] Open
Abstract
Participation rates in cancer genetic counseling differ among populations, as patients with a lower educational background and migrant patients seem to have poorer access to it. We conducted a study to determine the present-day educational level and migrant status of counselees referred to cancer genetic counseling. We assessed personal characteristics and demographics of 731 newly referred counselees. Descriptive statistics were used to describe these characteristics. The results show that about 40% of the counselees had a high educational level and 89% were Dutch natives. Compared to the Dutch population, we found a significant difference in educational level (p = < 0.01) and migrant status (p = < 0.001). This suggests disparities in cancer genetic counseling and as a result of that, suboptimal care for vulnerable groups. Limited health literacy is likely to pose a particular challenge to cancer genetic counseling for counselees with a lower education or a migrant background. Our study points to considerable scope for improvement in referring vulnerable groups of patients for cancer genetic counseling.
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Affiliation(s)
- J A M van der Giessen
- Department of Genetics, Division of Biomedical Genetics, University Medical Center Utrecht, PO Box 85090, Utrecht, 3508 AB, The Netherlands
| | - E van Riel
- Department of Genetics, Division of Biomedical Genetics, University Medical Center Utrecht, PO Box 85090, Utrecht, 3508 AB, The Netherlands
| | - M E Velthuizen
- Department of Genetics, Division of Biomedical Genetics, University Medical Center Utrecht, PO Box 85090, Utrecht, 3508 AB, The Netherlands
| | - A M van Dulmen
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands.,Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands.,Faculty of Health Sciences, University College of Southeast Norway, Drammen, Norway
| | - M G E M Ausems
- Department of Genetics, Division of Biomedical Genetics, University Medical Center Utrecht, PO Box 85090, Utrecht, 3508 AB, The Netherlands.
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Weller D. Our multidisciplinary journal: November 2016 issue takes us from spirituality to long-term survivors of childhood cancer. Eur J Cancer Care (Engl) 2017; 25:919-920. [PMID: 27781341 DOI: 10.1111/ecc.12604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- D Weller
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK.
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