Computer support for recording and interpreting family histories of breast and ovarian cancer in primary care (RAGs): qualitative evaluation with simulated patients
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This qualitative evaluation explored the context in which a computer program for assessing genetic risk of cancer would be used in general practice and issues surrounding its integration into a consultation Most of the doctors found the program easy to use, but it affected their control of the consultation—because of their desire to share the computer screen with the patient and their inability to anticipate the information that would be displayed.Abstract:
Objectives: To explore general practitioners9 attitudes towards and use of a computer program for assessing genetic risk of cancer in primary care. Design: Qualitative analysis of semistructured interviews and video recordings of simulated consultations. Participants: Purposive sample of 15 general practitioners covering a range of computer literacy, interest in genetics, age, and sex. Interventions: Each doctor used the program in two consultations in which an actor played a woman concerned about her family history of cancer. Consultations were videotaped and followed by interviews with the video as a prompt to questioning. Main outcome measures: Use of computer program in the consultation. Results: The program was viewed as an appropriate application of information technology because of the complexity of cancer genetics and a sense of “guideline chaos” in primary care. Doctors found the program easy to use, but it often affected their control of the consultation. They needed to balance their desire to share the computer screen with the patient, driven by their concerns about the effect of the computer on doctor-patient communication, against the risk of premature disclosure of bad news. Conclusions: This computer program could provide the necessary support to assist assessment of genetic risk of cancer in primary care. The potential impact of computer software on the consultation should not be underestimated. This study highlights the need for careful evaluation when developing medical information systems. Key messages General practitioners are under increasing pressure to advise their patients about genetic predisposition to various diseases Computers could help doctors to give genetic advice by simplifying the construction and assessment of family trees and implementing referral guidelines This qualitative evaluation explored the context in which a computer program for assessing genetic risk of cancer would be used in general practice and issues surrounding its integration into a consultation Most of the doctors found the program easy to use, but it affected their control of the consultation—because of their desire to share the computer screen with the patient and their inability to anticipate the information that would be displayed The study identified important issues relating to the use of computers in consultations which may be of use in testing software for primary care in the futureread more
Citations
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A family genetic risk communication framework: guiding tool development in genetics health services
TL;DR: The family genetic risk communication framework presents a concise synthesis of the evidence on family communication of genetic information; it may be useful in creating and evaluating tools to help genetic counsellors and patients with communication issues.
Journal ArticleDOI
Raising concerns about family history of breast cancer in primary care consultations: prospective, population based study. Women's Concerns Study Group.
Fawzia Hyland,Ann Louise Kinmonth,Theresa M. Marteau,Simon J. Griffin,Paul Murrell,David Spiegelhalter,Chris Todd,Fiona M Walter,B Berrington,Martin Bobrow,J Mackay +10 more
TL;DR: There is a place for genetic advice in general practice and that further research could improve its effectiveness, and there is no evidence that surveillance is effective in women under 50.
Journal ArticleDOI
The GRAIDS Trial: the development and evaluation of computer decision support for cancer genetic risk assessment in primary care.
TL;DR: This research evaluates an approach to support high-quality advice about cancer genetics in primary care which could be applied more broadly as the understanding of complex disease genetics increases.
Journal ArticleDOI
From practice guidelines to clinical decision support: closing the loop
TL;DR: It is argued that decision support technology can address a number of issues raised in the editorials: providing clinical guidance in a form that is specific to individual patients; permitting and indeed supporting the exercise of professional clinical judgement if this conflicts with general guidelines, and involving working clinicians in the translation of research into practice.
Journal ArticleDOI
Internet-based risk assessment and decision support for the management of familial cancer in primary care: a survey of GPs’ attitudes and intentions
TL;DR: GP users of the physician portal www.ukpractice.net value GRAIDS as an aid for the management of familial cancer in primary care and could be important in promoting the use of such technology to support high quality advice about genetic issues inPrimary care.
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Qualitative evaluation and research methods
TL;DR: The Nature of Qualitative Inquiry Theoretical Orientations Particularly Appropriate Qualitative Applications as mentioned in this paper, and Qualitative Interviewing: Qualitative Analysis and Interpretation Enhancing the quality and credibility of qualitative analysis and interpretation.
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Basics of qualitative research: Grounded theory procedures and techniques
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Interpreting Qualitative Data : Methods for Analysing Talk, Text and Interaction
TL;DR: This book has been substantially rewritten with the aim of greater clarity and a considerably expanded treatment of discourse analysis are provided in the new edition as discussed by the authors, which takes account of the growing interest in qualitative research outside sociology and anthropology from psychology to information systems, health promotion, management and many other disciplines.