Factors influencing the referrals in primary care of asymptomatic patients with a family history of cancer.
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.
Al-Habsi
Hamdan
H
Department of Family Medicine and Public Health, Sultan Qaboos University, Oman.
Lim
Jennifer N W
JN
Chu
Carol E
CE
Hewison
Jenny
J
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