title: Supporting genetics in primary care: investigating how theory can inform professional education.
abstract: Evidence indicates that many barriers exist to the integration of genetic case finding into primary care. We conducted an exploratory study of the determinants of three specific behaviours related to using breast cancer genetics referral guidelines effectively: 'taking a family history', 'making a risk assessment', and 'making a referral decision'. We developed vignettes of primary care consultations with hypothetical patients, representing a wide range of genetic risk for which different referral decisions would be appropriate. We used the Theory of Planned Behavior to develop a survey instrument to capture data on behavioural intention and its predictors (attitude, subjective norm, and perceived behavioural control) for each of the three behaviours and mailed it to a sample of Canadian family physicians. We used correlation and regression analyses to explore the relationships between predictor and dependent variables. The response rate was 96/125 (77%). The predictor variables explained 38-83% of the variance in intention across the three behaviours. Family physicians' intentions were lower for 'making a risk assessment' (perceived as the most difficult) than for the other two behaviours. We illustrate how understanding psychological factors salient to behaviour can be used to tailor professional educational interventions; for example, considering the approach of behavioural rehearsal to improve confidence in skills (perceived behavioural control), or vicarious reinforcement as where participants are sceptical that genetics is consistent with their role (subjective norm).
authors.affiliation: School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Brenda J
authors.initials: BJ
authors.lastname: Wilson
authors.affiliation: Centre for Practice Changing Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
authors.forename: Rafat
authors.initials: R
authors.lastname: Islam
authors.affiliation: School of Health Sciences, City University London, London, UK.
authors.forename: Jill J
authors.initials: JJ
authors.lastname: Francis
authors.affiliation: School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada.|Centre for Practice Changing Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.|Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Jeremy M
authors.initials: JM
authors.lastname: Grimshaw
authors.affiliation: Department of Family Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada.
authors.forename: Joanne A
authors.initials: JA
authors.lastname: Permaul
authors.affiliation: Department of Paediatrics, University of Ottawa, Ottawa, Ontario, Canada.|Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
authors.forename: Judith E
authors.initials: JE
authors.lastname: Allanson
authors.affiliation: STAR Family Health Team, Stratford, Ontario, Canada.|Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Sean
authors.initials: S
authors.lastname: Blaine
authors.affiliation: School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada.|Centre for Practice Changing Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
authors.forename: Ian D
authors.initials: ID
authors.lastname: Graham
authors.affiliation: Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada.|Genetics Program, North York General Hospital, Toronto, Ontario, Canada.
authors.forename: Wendy S
authors.initials: WS
authors.lastname: Meschino
authors.affiliation: Health Services Research Unit, University of Aberdeen, Aberdeen, UK.
authors.forename: Craig R
authors.initials: CR
authors.lastname: Ramsay
authors.affiliation: Department of Family Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada.|Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: June C
authors.initials: JC
authors.lastname: Carroll
mesh_terms: D002170:Canada; D000066491:Clinical Decision-Making; D030541:Databases, Genetic; D004502:Education, Medical, Continuing / Q000379:methods*; D005820:Genetic Testing / Q000592:standards*; D005826:Genetics, Medical / Q000193:education*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D058007:Physicians, Primary Care / Q000193:education* / Q000523:psychology; D011320:Primary Health Care / Q000592:standards*; D012017:Referral and Consultation / Q000592:standards