Family Practice Vol. 16, No. 5, 468-474
© Oxford University Press 1999
GPs' views on their role in cancer genetics services and current practice
Imperial Cancer Medical Oncology Unit, Western General Hospital, Edinburgh EH4 2XU,
a Department of Public Health Sciences, University of Edinburgh, Medical School, Teviot Place, Edinburgh EH8 9AG,
b Clinical Genetics Department, Molecular Medicine Centre, Western General Hospital, Edinburgh EH14 5JG and
c Lothian Health, Deaconess House, 148 Pleasance, Edinburgh EH8 9RS, UK.
Dr A Fry, Department of Clinical Psychology, Outpatient Building, Western General Hospital, Crewe Road, Edinburgh EH4 2XU, UK.
Background. Increasing demand for cancer genetics services has necessitated an urgent review of how these services are organized and, in particular, identification of an effective role for primary care.
Objectives. We aimed to assess the views of GPs on their role in cancer genetics services and their confidence in performing that role; to assess their understanding of cancer genetics, current practice and referral behaviour; and to identify needs for information and training to enable GPs to play an effective role in these services.
Method. A cross-sectional questionnaire survey of GPs was conducted through general practices in SE Scotland; 397 (response rate 59.3%) GPs returned a completed questionnaire. Outcome measures were: responders' perceptions of their role in cancer genetics services; confidence within that role; understanding of cancer genetics; current practice regarding patients presenting with concerns about their family history of cancer; and perceived information and training needs.
Results. GPs identified their role to be: taking a family history; making appropriate referrals to specialist services; providing emotional support; teaching breast self-examination; and discussing need for screening. Lack of confidence within this role was reflected in low levels of understanding of cancer genetics and in inappropriate referral practices. Concerns were expressed about the increasingly specialist role demanded of primary care. A desire for referral guidelines and community genetics clinics was identified.
Conclusions. GPs readily identify a role for themselves in cancer genetics services, but admit to a lack of confidence in this area, calling for clear referral guidelines and specialist community support. Current inappropriate referral to specialist services results from a lack of confidence in estimating cancer risk, highlighting the need for the development of clear referral criteria. Given the rapidly increasing demand for cancer genetics services and the vital role of primary care, it is important to identify a model of these services that facilitates effective involvement of GPs without further increasing their workload.
Keywords. Cancer, family practice, genetics, primary health care.
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