title: Factors influencing the referrals in primary care of asymptomatic patients with a family history of cancer.
abstract: OBJECTIVE
  To describe the events and the reasoning that led UK general practitioners to make a direct referral to a genetics clinic for a family history of cancer.
  
  
  METHODS
  Asymptomatic patients with a family history of cancer and general practitioners who had referred them to a genetics clinic were eligible to participate. Semi-structured interviews incorporating a self-completed questionnaire were conducted with the general practitioners. Questions about the referral had to be framed in general terms as few general practitioners could remember the index case. Individual face-to-face interviews based on a topic guide were conducted with the patients.
  
  
  RESULTS
  Thirty-six of 54 eligible general practitioners and 71 asymptomatic patients with a family history of cancer completed the study. General practitioners adopted a reactive rather than proactive role in the provision of genetic services for asymptomatic patients with a family history of cancer. Most general practitioners favored cancer diagnostic clinics as a referral pathway, and made a referral to genetics only when patients or a hospital doctor specifically requested this. More idiosyncratic approaches to the referral decision were also encountered. Updating of skills and knowledge in genetics remained a low priority despite acknowledged inadequacies.
  
  
  CONCLUSIONS
  Referral guidelines that are practicable in the context of a busy primary care clinic need to be developed if primary care practitioners are to play the major role desired for them in genetics.
authors.affiliation: Department of Family Medicine and Public Health, Sultan Qaboos University, Oman.
authors.forename: Hamdan
authors.initials: H
authors.lastname: Al-Habsi
authors.forename: Jennifer N W
authors.initials: JN
authors.lastname: Lim
authors.forename: Carol E
authors.initials: CE
authors.lastname: Chu
authors.forename: Jenny
authors.initials: J
authors.lastname: Hewison
mesh_terms: D000328:Adult; D001007:Anxiety; D001291:Attitude of Health Personnel; D005260:Female; D005817:Genetic Counseling; D005820:Genetic Testing; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000145:classification / Q000175:diagnosis* / Q000235:genetics; D010819:Physician's Role; D010821:Physicians, Family / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012017:Referral and Consultation; D011795:Surveys and Questionnaires; D006113:United Kingdom