Format

Send to

Choose Destination
Br J Gen Pract. 2018 Nov;68(676):e750-e756. doi: 10.3399/bjgp18X699533.

Identifying patients with a history of ovarian cancer for referral for genetic counselling: non-randomised comparison of two case-finding strategies in primary care.

Author information

1
Julius Center for Health Sciences and Primary Care.
2
Department of Genetics, Division of Biomedical Genetics, University Medical Center Utrecht, Utrecht University, the Netherlands; NIVEL (Netherlands Institute for Health Services Research), Utrecht, the Netherlands.
3
Department of Genetics, Division of Biomedical Genetics, University Medical Center Utrecht, Utrecht University, the Netherlands.
4
Dutch College of General Practitioners, Utrecht, the Netherlands.
5
Department of Gynaecological Oncology, UMC Utrecht Cancer Center, Utrecht University, the Netherlands.
6
Huisartsenpraktijk Kievitstraat, Woerden, the Netherlands.
7
Department of Medical Oncology, UMC Utrecht Cancer Center, Utrecht University, the Netherlands.
8
NIVEL, Utrecht; Radboud University Medical Center, Department of Primary and Community Care, Nijmegen, the Netherlands.

Abstract

BACKGROUND:

Recent guidelines recommend genetic counselling and DNA testing (GCT) for patients with ovarian cancer and survivors of ovarian cancer. Finding survivors of ovarian cancer is challenging. Detecting and referring them for GCT via primary care, to allow proper screening recommendations for patients and their family, may be a solution.

AIM:

To compare the effectiveness and acceptance of two pilot strategies directed at case finding women with a history of ovarian cancer for referral for GCT by their GP.

DESIGN AND SETTING:

Non-randomised comparison of the pilot implementation of two case-finding strategies for women with a history of ovarian cancer in Dutch primary care from May 2016 to April 2017.

METHOD:

Strategy A (unsupported) asked GPs to identify and refer eligible patients with a history of ovarian cancer. Strategy B (ICT-supported) provided GPs with information and communication technology (ICT) support to identify patients with a history of ovarian cancer electronically. The effectiveness of each strategy was assessed as the proportion of patients who were approached, referred for GCT, and seen by the clinical geneticist. Acceptance of each strategy was assessed by the intervention uptake of GP practices and GP and patient questionnaires.

RESULTS:

Nineteen out of 30 (63%) patients identified with a history of ovarian cancer were deemed eligible for referral for strategy A, and 39 out of 94 (41%) for strategy B. For each strategy, eight patients were referred and five (63%) were seen for GCT. The intervention uptake by GP practices was 31% (11 out of 36) for strategy A and 46% (21 out of 46) for strategy B. GPs considered 'relevance' and 'workability' as facilitators across both strategies whereas, for strategy B, technical barriers hindered implementation.

CONCLUSION:

The effectiveness and acceptance of both strategies for case finding of survivors of ovarian cancer in primary care for GCT is promising, but larger studies are required before wide-scale implementation is warranted.

KEYWORDS:

DNA testing; case finding; genetic counselling; ovarian cancer; primary care; referral

Supplemental Content

Full text links

Icon for HighWire Icon for PubMed Central
Loading ...
Support Center