Bankhead C, Emery J, Qureshi N, Campbell H, Austoker J, Watson E
CRC Primary Care Education Research Group, University of Oxford, UK.
Fam Pract. 2001 Oct;18(5):475-86. doi: 10.1093/fampra/18.5.475.
In response to increased referrals to geneticists and the predicted patient demand for genetic counselling, it has been proposed that some genetics services should be provided in primary care. Practice nurses are ideally placed to collect family history information and advise patients accordingly in new patient, family planning, well women/men and chronic disease clinics, but little is known about their knowledge, skills and attitudes towards providing genetic advice.
The survey aimed to measure the current situation with regard to: the prevalence of family history recording by practice nurses; confidence in collecting and acting upon family history; and practice nurses' knowledge about familial disorders and genetics. It also investigated what practice nurses think their role should be in relation to the delivery of genetic services; their educational needs; and the most appropriate ways of delivering training/support.
A postal questionnaire survey was carried out of all practices nurses (n = 909) in four Health Authorities in England (Oxfordshire, Northamptonshire, Nottingham and North Nottinghamshire) and one Health Board in Scotland (Lothian). Analyses were primarily descriptive.
A total of 600 nurses (response rate = 66.0%) returned a completed questionnaire. Ninety-six per cent of practice nurses reported that they routinely collect family history information. Over half of the respondents had been consulted in the previous 3 months by patients with a worry about family history of cancer. Approximately 60% of nurses felt confident about collecting the relevant details regarding a family history of breast cancer but felt less confident in collecting the information regarding familial colorectal cancer. Nurses were also unsure how to proceed, with over a third of nurses referring patients to the GP even if they thought the patient was at population risk or, conversely, not referring those that they thought were at considerably higher risk to the GP. There was a reported need for education about familial disease in general and overall agreement that nurses could play a role in genetics in primary care.
This study provides evidence of considerable activity from practice nurses regarding routine collection of family history. There is a need for further education for practice nurses regarding family history information and the new genetics so that this information is managed appropriately.
为应对转介给遗传学家的病例增加以及预计患者对遗传咨询的需求，有人提议应在初级保健中提供一些遗传学服务。执业护士非常适合在新患者、计划生育、健康女性/男性及慢性病诊所收集家族史信息并据此为患者提供建议，但对于他们提供遗传咨询的知识、技能和态度却知之甚少。
该调查旨在衡量以下方面的现状：执业护士记录家族史的普遍程度；收集家族史并据此采取行动的信心；以及执业护士对家族性疾病和遗传学的知识。它还调查了执业护士认为自己在提供遗传服务方面应扮演的角色；他们的教育需求；以及提供培训/支持的最合适方式。
对英格兰四个卫生当局（牛津郡、北安普敦郡、诺丁汉和北诺丁汉郡）和苏格兰一个卫生委员会（洛锡安）的所有执业护士（n = 909）进行了邮寄问卷调查。分析主要是描述性的。
共有600名护士（回复率 = 66.0%）返回了完整的问卷。96%的执业护士报告说他们经常收集家族史信息。超过一半的受访者在过去3个月中曾被担心癌症家族史的患者咨询过。约60%的护士对收集乳腺癌家族史的相关细节有信心，但对收集家族性结直肠癌的信息信心不足。护士们也不确定如何处理，超过三分之一的护士即使认为患者处于一般风险中也会将患者转介给全科医生，或者相反，对于那些他们认为风险高得多的患者却不转介给全科医生。据报告，总体上需要有关家族性疾病的教育，并且普遍认为护士可以在初级保健的遗传学中发挥作用。
本研究提供了证据，表明执业护士在常规收集家族史方面有大量工作。需要对执业护士进行关于家族史信息和新遗传学的进一步教育，以便对这些信息进行适当管理。
