Genetics counseling in primary care improves cancer referrals
These are the conclusions of UK researchers from the University of Southampton, who found that educating general practitioners (GPs) about genetic testing helped them to make more appropriate referrals, while the majority of cancer referrals were managed effectively without patients needing to attend a hospital based genetics counseling clinic.
Writing in the British Journal of General Practice, Greta Westwood and colleagues explain that the UK National Health Service (NHS) aims to integrate more secondary care services with primary care "to provide flexible, responsive, and patient-centered care closer to home."
The researchers evaluated the impact of genetics counselor-led education on cancer and noncancer referral rates, and how the clinic setting affects attendance rates.
They randomized 73 family practices to receive a case scenario practice-based seminar (education) or no intervention (control), and their patients to have a genetics counselor-led appointment in primary or secondary (control) care.
The seminar included four case scenarios, on cystic fibrosis, Huntington's disease, breast cancer, and a child with dysmorphic features, as well as referral access details and local and national cancer family history guidelines available on an NHS intranet secure website.
Results showed that a total of 89 referrals were made by practices in the educated group, and 68 in the control group. Analysis of these by a clinical genetics services clinician against referral guidelines indicated that significantly more GP cancer referrals in the educated group were appropriate, at 23 compared with 10, translating into a 2.3-fold relative increase in appropriate referrals.
In all, 311 genetics counselor-led appointments were offered to patients, 170 in primary and 141 in secondary care. Of these, a total of 17 patients cancelled and 39 did not attend. There was no evidence that the clinic attendance rates differed between those invited to primary and those secondary care; nor was patient satisfaction altered by the clinic location.
Nevertheless, patients spent 49% less money on travelling to a primary than secondary care clinic and travelled 33% less distance. And, the researchers report, 60% of GP and 80% of all cancer referrals (irrespective of the referrer) were managed by genetics counselor-led primary care clinics without the need for a hospital appointment, and 83% of these met the 18-week target referral-to-treatment time.
They conclude: "This trial shows that integrated primary care genetic services support GPs in appropriate cancer referral, providing care in the right place by the right person."
Clare Gerada, Chair of the UK Royal College of General Practitioners, commented: "This study is really revealing because it demonstrates that with training and access to community services, GPs can improve the experience of patients with a greater genetic risk of developing cancer, making the best possible use of the NHS's excellent specialist genetics services."
By Caroline Price