BMJ 2000;321:28-32 ( 1 July )

Information in practice

Computer support for interpreting family histories of breast and ovarian cancer in primary care: comparative study with simulated cases

Jon Emery, Cancer Research Campaign primary care oncology research fellow, ^a Robert Walton, senior research fellow, ^a Michael Murphy, director, ^a Joan Austoker, director, ^b Pat Yudkin, lecturer in medical statistics, ^c Cyril Chapman, consultant clinical geneticist, ^d Andrew Coulson, research fellow, ^e David Glasspool, research fellow, ^e John Fox, head. ^e

^a ICRF General Practice Research Group, Division of Public Health and Primary Health Care, Institute of Health Sciences, University of Oxford, Oxford OX3 7LF, ^b Cancer Research Campaign Primary Care Education Research Group, Division of Public Health and Primary Health Care, University of Oxford, ^c Department of Primary Health Care, University of Oxford, ^d Department of Clinical Genetics, Oxford Radcliffe NHS Trust, Churchill Hospital, Oxford OX3 7JL, ^e ICRF Advanced Computation Laboratory, PO Box 123, London WC2A 3PX

Correspondence to: J Emery jon.emery{at}dphpc.ox.ac.uk

Objectives: To evaluate the potential effect of computer support on general practitioners' management of familial breast and ovarian cancer, and to compare the effectiveness of two different types of computer program.
Design: Crossover experiment with balanced block design.
Participants: Of a random sample of 100 general practitioners from Buckinghamshire who were invited, 41 agreed to participate. From these, 36 were selected for a fully balanced study.
Interventions: Doctors managed 18 simulated cases: 6 with computerised decision support system Risk Assessment in Genetics (RAGs), 6 with Cyrillic (an established pedigree drawing program designed for clinical geneticists), and 6 with pen and paper.
Main outcome measures: Number of appropriate management decisions made (maximum 6), mean time taken to reach a decision, number of pedigrees accurately drawn (maximum 6). Secondary measures were method of support preferred for particular aspects of managing family histories of cancer; importance of specific information on cancer genetics that might be provided by an "ideal computer program."
Results: RAGs resulted in significantly more appropriate management decisions (median 6) than either Cyrillic (median 3) or pen and paper (median 3); median difference between RAGs and Cyrillic 2.5 (95% confidence interval 2.0 to 3.0; P<0.0001). RAGs also resulted in significantly more accurate pedigrees (median 5) than both Cyrillic (median 3.5) and pen and paper (median 2); median difference between RAGs and Cyrillic 1.5 (1.0 to 2.0; P<0.0001). The time taken to use RAGs (median 178 seconds) was 51 seconds longer per case (95% confidence interval 36 to 65; P<0.0001) than pen and paper (median 124 seconds) but was less than Cyrillic (median 203 seconds; difference 23. (5 to 43; P=0.02)). 33 doctors (92% (78% to 98%)) preferred using RAGs overall. The most important elements of an "ideal computer program" for genetic advice in primary care were referral advice, the capacity to create pedigrees, and provision of evidence and explanations to support advice.
Conclusions: RAGs could enable general practitioners to be more effective gatekeepers to genetics services, empowering them to reassure the majority of patients with a family history of breast and ovarian cancer who are not at increased genetic risk.

---

© BMJ 2000
CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Relevant Articles

Designing and evaluating complex interventions to improve health care

Neil C Campbell, Elizabeth Murray, Janet Darbyshire, Jon Emery, Andrew Farmer, Frances Griffiths, Bruce Guthrie, Helen Lester, Phil Wilson, and Ann Louise Kinmonth
BMJ 2007 334: 455-459. [Extract] [Full Text] [PDF]

Family histories of cancer in primary care

M H Shere, Emma Gray, Neil Rothnie, and Amanda Fowler
BMJ 2000 321: 955. [Extract] [Full Text]

Computer support helps GPs interpret family histories of cancer
BMJ 2000 321: 0. [Full Text]

This article has been cited by other articles:

• Campbell, N. C, Murray, E., Darbyshire, J., Emery, J., Farmer, A., Griffiths, F., Guthrie, B., Lester, H., Wilson, P., Kinmonth, A. L. (2007). Designing and evaluating complex interventions to improve health care. BMJ 334: 455-459 [Full text]  
• Acheson, L. S., Zyzanski, S. J., Stange, K. C., Deptowicz, A., Wiesner, G. L. (2006). Validation of a Self-Administered, Computerized Tool for Collecting and Displaying the Family History of Cancer. JCO 24: 5395-5402 [Abstract] [Full text]  
• Wilson, B. J, Torrance, N., Mollison, J., Watson, M S., Douglas, A., Miedzybrodzka, Z., Gordon, R., Wordsworth, S., Campbell, M., Haites, N., Grant, A. (2006). Cluster randomized trial of a multifaceted primary care decision-support intervention for inherited breast cancer risk. Fam Pract 23: 537-544 [Abstract] [Full text]  
• U.S. Preventive Services Task Force*, (2005). Genetic Risk Assessment and BRCA Mutation Testing for Breast and Ovarian Cancer Susceptibility: Recommendation Statement. ANN INTERN MED 143: 355-361 [Abstract] [Full text]  
• Nelson, H. D., Huffman, L. H., Fu, R., Harris, E. L. (2005). Genetic Risk Assessment and BRCA Mutation Testing for Breast and Ovarian Cancer Susceptibility: Systematic Evidence Review for the U.S. Preventive Services Task Force. ANN INTERN MED 143: 362-379 [Abstract] [Full text]  
• Walter, F. M., Emery, J. (2005). 'Coming Down the Line'-- Patients' Understanding of Their Family History of Common Chronic Disease. Ann Fam Med 3: 405-414 [Abstract] [Full text]  
• Walter, F. M., Emery, J., Braithwaite, D., Marteau, T. M. (2004). Lay Understanding of Familial Risk of Common Chronic Diseases: A Systematic Review and Synthesis of Qualitative Research. Ann Fam Med 2: 583-594 [Abstract] [Full text]  
• Sifri, R., Gangadharappa, S., Acheson, L. S. (2004). Identifying and Testing for Hereditary Susceptibility to Common Cancers. CA Cancer J Clin 54: 309-326 [Abstract] [Full text]  
• Sutton, D. R., Fox, J. (2003). The Syntax and Semantics of the PROforma Guideline Modeling Language. J. Am. Med. Inform. Assoc. 10: 433-443 [Abstract] [Full text]  
• Braithwaite, D., Sutton, S., Smithson, W H., Emery, J. (2002). Internet-based risk assessment and decision support for the management of familial cancer in primary care: a survey of GPs' attitudes and intentions. Fam Pract 19: 587-590 [Abstract] [Full text]  
• McAllister, M, O'Malley, K, Hopwood, P, Kerr, B, Howell, A, Evans, D G R (2002). Management of women with a family history of breast cancer in the North West Region of England: training for implementing a vision of the future. J. Med. Genet. 39: 531-535 [Full text]  
• Elwyn, G., Iredale, R., Gray, J. (2002). Reactions of GPs to a triage-controlled referral system for cancer genetics. Fam Pract 19: 65-71 [Abstract] [Full text]  
• Bankhead, C., Emery, J., Qureshi, N., Campbell, H., Austoker, J., Watson, E. (2001). New developments in genetics--knowledge, attitudes and information needs of practice nurses. Fam Pract 18: 475-486 [Abstract] [Full text]  
• Rose, P. W, Watson, E., Yudkin, P., Emery, J., Murphy, M., Fuller, A., Lucassen, A. (2001). Referral of patients with a family history of breast/ovarian cancer--GPs' knowledge and expectations. Fam Pract 18: 487-490 [Abstract] [Full text]  
• Emery, J., Hayflick, S. (2001). The challenge of integrating genetic medicine into primary care. BMJ 322: 1027-1030 [Full text]  
• Pagon, R. A, Pinsky, L., Beahler, C. C (2001). Online medical genetics resources: a US perspective. BMJ 322: 1035-1037 [Full text]  
• Shere, M H, Gray, E., Rothnie, N., Fowler, A. (2000). Family histories of cancer in primary care. BMJ 321: 955-955 [Full text]  

Rapid Responses:

Read all Rapid Responses

Computer support for interpreting family histories in Primary Care

M H Shere
bmj.com, 4 Jul 2000 [Full text]

Primary care- the right setting for discussion of family history risk?

Morph May
bmj.com, 19 Jul 2000 [Full text]