title: Easy-to-use online referral test detects most patients with a high familial risk of colorectal cancer.
abstract: OBJECTIVE
  Currently only 12-30% of individuals with a high risk of Lynch syndrome, the most common hereditary colorectal cancer (CRC) syndrome, are referred for genetic counselling. We assessed the sensitivity, usability and user experiences of a new online referral test aimed at improving referral of high-risk individuals for genetic counselling.
  
  
  METHODS
  Sensitivity was assessed by entering pedigree data from high-risk individuals (i.e. Lynch syndrome mutation carriers) into the referral test to determine whether genetic counselling was recommended. For usability, we assessed nonmedical staff members' ability to determine referral, according to guidelines, in seven fictive clinical cases using the referral test after minimal training. Real-life users answered questions about their experience with the referral test.
  
  
  RESULTS
  Sensitivity of the referral test was 91% for mutation carriers with CRC (n = 164) and 73% for all affected and nonaffected mutation carriers (n = 420). Nonmedical staff members (n = 20) determined referral according to guidelines in 84% of cases using the referral test. Ten per cent (256/2470) of real-life users provided feedback about experiences; of those, 71% reported that the referral test increased reassurance, certainty about their familial risk and/or certainty about referral.
  
  
  CONCLUSIONS
  The referral test has a high sensitivity in detecting individuals with a high risk of Lynch syndrome and is suitable for use in clinical practice. Widespread use of the referral test should improve cancer prevention in high-risk patients and their relatives.
authors.affiliation: Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands; Department of Human Genetics, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands.
authors.forename: N
authors.initials: N
authors.lastname: Dekker
authors.forename: R P M G
authors.initials: RP
authors.lastname: Hermens
authors.forename: A R
authors.initials: AR
authors.lastname: Mensenkamp
authors.forename: W A G
authors.initials: WA
authors.lastname: van Zelst-Stams
authors.forename: N
authors.initials: N
authors.lastname: Hoogerbrugge
mesh_terms: D000328:Adult; D000368:Aged; D015179:Colorectal Neoplasms / Q000235:genetics; D003123:Colorectal Neoplasms, Hereditary Nonpolyposis / Q000175:diagnosis / Q000235:genetics*; D003936:Diagnosis, Computer-Assisted / Q000379:methods*; D005260:Female; D005817:Genetic Counseling; D005820:Genetic Testing; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D010375:Pedigree; D012017:Referral and Consultation; D018570:Risk Assessment / Q000379:methods*; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires
keywords: Colorectal cancer; familial risk assessment; genetic counseling; referral test