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Family Practice Advance Access originally published online on June 20, 2006
Family Practice 2006 23(5):537-544; doi:10.1093/fampra/cml026
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© The Author (2006). Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Cluster randomized trial of a multifaceted primary care decision-support intervention for inherited breast cancer risk

Brenda J Wilsona, Nicola Torrancea, Jill Mollisona, M Stuart Watsona, Alison Douglasb, Zosia Miedzybrodzkac, Richard Gordond, Sarah Wordsworthe, Marion Campbelld, Neva Haitesc and Adrian Grantd

a Department of Public Health, University of Aberdeen Aberdeen, UK
b Woodside Medical Practice Aberdeeen, UK
c Department of Medicine & Therapeutics, University of Aberdeen Aberdeen, UK
d Health Services Research Unit, University of Aberdeen Aberdeen, UK
e Health Economics Research Unit, University of Aberdeen Aberdeen, UK

Correspondence to Dr Brenda J Wilson, Department of Epidemiology & Community Medicine, University of Ottawa, 451 Smyth Road, Ottawa, Ontario K1H 8M5, Canada; Email: brenda.wilson{at}uottawa.ca

Background. GPs are increasingly expected to meet the needs of patients concerned about their risk of inherited breast cancer, but may lack skills or confidence to use complex management guidelines. We developed an evidence-based, multifaceted intervention intended to promote confidence and skills in this area.

Objective. To evaluate the effectiveness of the intervention in improving GP confidence in managing patients concerned about genetic risk of breast cancer.

Methods.

Design. Cluster randomized controlled trial.

Setting. General practices in the Grampian region of Scotland.

Subjects. GPs and the patients they referred for genetic counselling for risk of breast cancer.

Main outcome measures. GPs’ self-reported confidence in four activities related to genetics; rates of referral of patients at elevated genetic risk; and referred patients’ understanding of cancer risk factors.

Results. No statistically significant differences were observed between intervention and control arms in the primary or secondary outcomes. A possible effect of the intervention on the proportion of referred patients who were at elevated risk could not be discounted. Only a small proportion of intervention GPs attended the educational session, were aware or the software, or made use of it in practice.

Conclusions. No convincing evidence of the effectiveness of the intervention was found, probably reflecting barriers to its use in routine practice.

Keywords. Breast neoplasms, computer-assisted decision making, family physicians, randomized controlled trials.


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