Watson E, Clements A, Yudkin P, Rose P, Bukach C, Mackay J, Lucassen A, Austoker J
CRC Primary Care Education Research Group, Department of Primary Health Care, University of Oxford, Institute of Health Sciences, Headington, Oxford OX3 7LF.
Br J Gen Pract. 2001 Oct;51(471):817-21.
It has been suggested that primary care should become more involved in providing genetic services, such as basic risk assessment, to enable patients with a moderate/high risk to be referred and those with a low risk to receive reassurance and advice from their general practitioner (GP). However, GPs currently lack knowledge and confidence in this area.
To investigate the effect of an in-practice educational session and information pack on GP management of familial breast/ovarian cancer cases.
Cluster randomised controlled trial.
GP principals in 170 practices in Oxfordshire and Northamptonshire. Of the 688 GPs, 426 (62%) participated.
Practices were randomised either to Group A (receiving an inpractice educational session plus information pack), Group B (receiving an information pack alone), or Group C (receiving neither an educational session nor a pack). The main study outcome was the proportion of GPs making the correct referral decision on at least five out of six family history vignettes. A secondary outcome was GPs' reported confidence in managing patients with a family history of breast/ovarian cancer, measured by a score that was generated by combining responses to four questions.
There was a 40% (95% CI = 30-50%, P < 0.001) improvement in the proportion of GPs who made the correct referral decision on at least five out of the six vignettes in Group A (111/140 [79%]) compared with Group C (controls) (63/162 [39%]), and a 42% (95% CI = 31-52%, P < 0.001) improvement in Group B (100/124 [81%]) compared with the control group. There was a trend in reported confidence in the management of individuals with a family history of breast/ovarian cancer from a mean confidence score of 2.3 in Group A to 2.0 in Group B and 1.5 in Group C (P < 0.001).
Providing GPs with an information pack significantly improved referral decisions regarding patients with a family history of breast/ovarian cancer. Although extremely well received, an in-house educational session produced no additional improvements. There were, however, greater levels of reported confidence in the group who received the educational session in addition to the information pack.
有人建议初级保健应更多地参与提供基因服务，如基本风险评估，以便将中度/高风险患者转诊，并让低风险患者从其全科医生（GP）处获得安心和建议。然而，全科医生目前在这一领域缺乏知识和信心。
调查一次实践中的教育课程和信息包对全科医生管理家族性乳腺癌/卵巢癌病例的影响。
整群随机对照试验。
牛津郡和北安普敦郡170家诊所的全科医生负责人。688名全科医生中，426名（62%）参与了研究。
诊所被随机分为A组（接受一次实践中的教育课程加信息包）、B组（仅接受信息包）或C组（既不接受教育课程也不接受信息包）。主要研究结果是全科医生在六个家族病史案例中至少对五个做出正确转诊决定的比例。次要结果是全科医生报告的对管理有乳腺癌/卵巢癌家族史患者的信心，通过综合对四个问题的回答得出的分数来衡量。
与C组（对照组）（63/162 [39%]）相比，A组（111/140 [79%]）中在六个案例中至少对五个做出正确转诊决定的全科医生比例提高了40%（95%置信区间 = 30 - 50%，P < 0.001）；与对照组相比，B组（100/124 [81%]）提高了42%（95%置信区间 = 31 - 52%，P < 0.001）。在管理有乳腺癌/卵巢癌家族史个体方面，报告的信心有一个趋势，从A组的平均信心得分2.3降至B组的2.0和C组的1.5（P < 0.001）。
为全科医生提供信息包显著改善了对有乳腺癌/卵巢癌家族史患者的转诊决定。虽然非常受欢迎，但内部教育课程并未带来额外改善。然而，除了信息包还接受了教育课程的组报告的信心水平更高。
