Rose Wai-Yee Fok1, Cheryl Siow Bin Ong2, Désirée Lie3, Diana Ishak1, Si Ming Fung1, Wern Ee Tang4, Shirley Sun2, Helen Smith5, Joanne Yuen Yie Ngeow6,7,8. 1. Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore. 2. Sociology, School of Social Sciences and Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore. 3. Signature Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore. 4. National Healthcare Group Polyclinics, Singapore, Singapore. 5. Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Singapore, 308282, Singapore. 6. Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore. joanne.ngeow@ntu.edu.sg. 7. Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Singapore, 308282, Singapore. joanne.ngeow@ntu.edu.sg. 8. Oncology Academic Clinical Program, Duke NUS Medical School, National University Singapore, Singapore, Singapore. joanne.ngeow@ntu.edu.sg.
Abstract
BACKGROUND: Genetic screening (GS), defined as the clinical testing of a population to identify asymptomatic individuals with the aim of providing those identified as high risk with prevention, early treatment, or reproductive options. Genetic screening (GS) improves patient outcomes and is accessible to the community. Family physicians (FPs) are ideally placed to offer GS. There is a need for FPs to adopt GS to address anticipated genetic specialist shortages. OBJECTIVE: To explore FP attitudes, perceived roles, motivators and barriers, towards GS; and explore similarities and differences between private and public sector FPs. METHODS: We developed a semi-structured interview guide using existing literature. We interviewed private and public sector FPs recruited by purposive, convenience and snowballing strategies, by telephone or video to theme saturation. All sessions were audio-recorded, transcribed and coded for themes by two independent researchers with an adjudicator. RESULTS: Thirty FPs were interviewed (15 private, 15 public). Theme saturation was reached for each group. A total of 12 themes (6 common, 3 from private-practice participants, 3 public-employed participants) emerged. Six common major themes emerged: personal lack of training and experience, roles and relevance of GS to family medicine, reluctance and resistance to adding GS to practice, FP motivations for adoption, patient factors as barrier, and potential solutions. Three themes (all facilitators) were unique to the private group: strong rapport with patients, high practice autonomy, and high patient literacy. Three themes (all barriers) were unique to the public group: lack of control, patients' lower socioeconomic status, and rigid administrative infrastructure. CONCLUSION: FPs are motivated to incorporate GS but need support for implementation. Policy-makers should consider the practice setting when introducing new screening functions. Strategies to change FP behaviours should be sensitive to their sense of autonomy, and the external factors (either as facilitators or as barriers) shaping FP practices in a given clinical setting.
BACKGROUND: Genetic screening (GS), defined as the clinical testing of a population to identify asymptomatic individuals with the aim of providing those identified as high risk with prevention, early treatment, or reproductive options. Genetic screening (GS) improves patient outcomes and is accessible to the community. Family physicians (FPs) are ideally placed to offer GS. There is a need for FPs to adopt GS to address anticipated genetic specialist shortages. OBJECTIVE: To explore FP attitudes, perceived roles, motivators and barriers, towards GS; and explore similarities and differences between private and public sector FPs. METHODS: We developed a semi-structured interview guide using existing literature. We interviewed private and public sector FPs recruited by purposive, convenience and snowballing strategies, by telephone or video to theme saturation. All sessions were audio-recorded, transcribed and coded for themes by two independent researchers with an adjudicator. RESULTS: Thirty FPs were interviewed (15 private, 15 public). Theme saturation was reached for each group. A total of 12 themes (6 common, 3 from private-practice participants, 3 public-employed participants) emerged. Six common major themes emerged: personal lack of training and experience, roles and relevance of GS to family medicine, reluctance and resistance to adding GS to practice, FP motivations for adoption, patient factors as barrier, and potential solutions. Three themes (all facilitators) were unique to the private group: strong rapport with patients, high practice autonomy, and high patient literacy. Three themes (all barriers) were unique to the public group: lack of control, patients' lower socioeconomic status, and rigid administrative infrastructure. CONCLUSION: FPs are motivated to incorporate GS but need support for implementation. Policy-makers should consider the practice setting when introducing new screening functions. Strategies to change FP behaviours should be sensitive to their sense of autonomy, and the external factors (either as facilitators or as barriers) shaping FP practices in a given clinical setting.
Entities:
Keywords:
Attitudes; Family physicians; Genetic screening; Primary care; Private; Public
Authors: Lauren Puryear; Natalie Downs; Andrea Nevedal; Eleanor T Lewis; Kelly E Ormond; Maria Bregendahl; Carlos J Suarez; Sean P David; Steven Charlap; Isabella Chu; Steven M Asch; Neda Pakdaman; Sang-Ick Chang; Mark R Cullen; Latha Palaniappan Journal: J Community Genet Date: 2017-12-27