title: Gatekeeper role of gastroenterologists and surgeons in recognising and discussing familial colorectal cancer.
abstract: This study aimed to gain insight into the gatekeeper role of surgeons and gastroenterologists (including residents) during a first consultation at a tertiary gastro-intestinal centre regarding referral for genetic counselling, and to test the feasibility of a checklist for indications for referral. Consecutive patients were invited before and after introduction of a checklist, to complete a questionnaire assessing their perception of discussing cancer genetic topics. Initial consultations were audiotaped to assess the quality of this discussion by gastroenterologists and surgeons. Data on completeness of the checklist and referral were collected from medical files. No significant differences were found between the Before and After group regarding patients' reports of discussing cancer in the family (77%, n = 34 vs 89%, n = 33, p = 0.16). In 28% (n = 10) of the audiotaped consultations family history was adequately discussed, in 58% (n = 21) it was considered inadequate and in 14% (n = 5) of consultations it was not discussed at all. A checklist was present in 53% (n = 27) of the medical files. Of these, 5 (19%) were incomplete. Gastroenterologists and surgeons (in training) have difficulty in fulfilling their gatekeeper role of recognizing patients at familial risk for CRC. Although they often discuss familial cancer during the initial consultation, their exploration seems insufficient to reveal indications for referral for genetic counselling. Therefore, healthcare professionals should not only understand genetics and the importance of cancer family history, but also be effective in the communication of this subject to enable more adequate referral of patients for genetic counselling.
authors.affiliation: Department of Medical Psychology, Academic Medical Center/University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands. k.f.douma@amc.uva.nl.
authors.forename: Kirsten F L
authors.initials: KF
authors.lastname: Douma
authors.affiliation: Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Evelien
authors.initials: E
authors.lastname: Dekker
authors.affiliation: Department of Medical Psychology, Academic Medical Center/University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands.
authors.forename: Ellen M A
authors.initials: EM
authors.lastname: Smets
authors.affiliation: Department of Clinical Genetics, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Cora M
authors.initials: CM
authors.lastname: Aalfs
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000235:genetics*; D005190:Family; D005260:Female; D000072102:Gastroenterologists; D005817:Genetic Counseling; D020022:Genetic Predisposition to Disease; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D012017:Referral and Consultation; D066231:Surgeons; D011795:Surveys and Questionnaires
keywords: Gastroenterology; Genetic testing; Health communication; Hereditary colorectal neoplasms; Risk assessment