(Computer support for recording and interpreting family histories of breast and ovarian cancer in primary care (RAGs): qualitative evaluation with simulated patients)
A new computer programme, to help family doctors work with patients to assess their genetic risk of cancer, seems to have faired well in initial trials, the results of which are published in this week's BMJ. A collaboration between the Cancer Research Campaign and the Imperial Cancer Research Fund, ‘risk assessment in genetics' (RAGs) is a computer programme which draws pedigrees, assesses risk based on a family history of breast and ovarian cancer and suggests an appropriate course of action.
The study was conducted with 15 general practitioners, each consulted by two female patients, played by actors, concerned about their risk of cancer. Most of the doctors involved in the study found the programme easy to use and that it enabled them to tackle the complex area of assessing genetic risk with their patients. However, users also reported a sense of ‘being out of control' during the consultation. For example, some participants found it awkward sitting next to their patient, with the screen in front of them, unable to predict the information that would be displayed. When the programme calculated that a patient should be considered ‘high risk' doctors commented that they felt a sense of panic and wanted to turn the screen away from the patient in order to break the bad news more gently.
The authors of the study also found that some users were uncomfortable with the speed of the programme. Some preferred to ‘stage' the process of assessment so that they had time to prepare themselves for presenting bad news to a patient. Some users found it difficult to access the additional information explaining what the risk assessment actually meant for the patient, which was contained within the programme. Once they found these explanations they were able to reassure the patient and feel more in control of the consultation.
The team conclude that RAGs could provide the necessary support to assist the assessment of the genetic risk of cancer in the primary care setting and report that the study throws up a need for some important changes to the software to improve the role of the programme within the doctor/patient consultation. They also note that their findings have identified a number of issues related to the use of computers in patient consultations that may have implications for the testing of software for primary care in the future.
Contact:
Dr Jon Emery, Cancer Research Campaign Primary Care Oncology Research Fellow, ICRF General Practice Research Group, Division of Public Health and Primary Health Care, Institute of Health Sciences, University of Oxford, Oxford jon.emery@green.ox.ac.uk
Esther Ferguson, Press Office, Cancer Research Campaign
Dr Iain Foulkes, Press Office, Imperial Cancer Research Fund