Julius Center for Health Sciences and Primary Care.
Department of Genetics, Division of Biomedical Genetics, University Medical Center Utrecht, Utrecht University, the Netherlands; NIVEL (Netherlands Institute for Health Services Research), Utrecht, the Netherlands.
Br J Gen Pract. 2018 Nov;68(676):e750-e756. doi: 10.3399/bjgp18X699533.
Recent guidelines recommend genetic counselling and DNA testing (GCT) for patients with ovarian cancer and survivors of ovarian cancer. Finding survivors of ovarian cancer is challenging. Detecting and referring them for GCT via primary care, to allow proper screening recommendations for patients and their family, may be a solution.
To compare the effectiveness and acceptance of two pilot strategies directed at case finding women with a history of ovarian cancer for referral for GCT by their GP.
Non-randomised comparison of the pilot implementation of two case-finding strategies for women with a history of ovarian cancer in Dutch primary care from May 2016 to April 2017.
Strategy A (unsupported) asked GPs to identify and refer eligible patients with a history of ovarian cancer. Strategy B (ICT-supported) provided GPs with information and communication technology (ICT) support to identify patients with a history of ovarian cancer electronically. The effectiveness of each strategy was assessed as the proportion of patients who were approached, referred for GCT, and seen by the clinical geneticist. Acceptance of each strategy was assessed by the intervention uptake of GP practices and GP and patient questionnaires.
Nineteen out of 30 (63%) patients identified with a history of ovarian cancer were deemed eligible for referral for strategy A, and 39 out of 94 (41%) for strategy B. For each strategy, eight patients were referred and five (63%) were seen for GCT. The intervention uptake by GP practices was 31% (11 out of 36) for strategy A and 46% (21 out of 46) for strategy B. GPs considered 'relevance' and 'workability' as facilitators across both strategies whereas, for strategy B, technical barriers hindered implementation.
The effectiveness and acceptance of both strategies for case finding of survivors of ovarian cancer in primary care for GCT is promising, but larger studies are required before wide-scale implementation is warranted.
最近的指南建议对卵巢癌患者和卵巢癌幸存者进行遗传咨询和 DNA 检测（GCT）。寻找卵巢癌幸存者具有挑战性。通过初级保健检测并转介他们进行 GCT，以便为患者及其家属提供适当的筛查建议，可能是一种解决方案。
比较两种针对卵巢癌病史女性进行病例发现以转介其家庭医生进行 GCT 的试点策略的有效性和接受程度。
2016 年 5 月至 2017 年 4 月，在荷兰初级保健中对两种卵巢癌病史女性病例发现策略的试点实施进行非随机比较。
策略 A（未提供支持）要求全科医生识别并转介符合条件的卵巢癌病史患者。策略 B（基于 ICT 的）为全科医生提供信息和通信技术（ICT）支持，以便通过电子方式识别卵巢癌病史患者。每个策略的有效性评估为被接触、转介进行 GCT 并由临床遗传学家就诊的患者比例。每个策略的接受度通过 GP 实践和 GP 和患者问卷进行评估。
通过 A 策略确定的 30 名（63%）卵巢癌病史患者中有 19 名被认为符合转介条件，而 B 策略中有 94 名（41%）符合条件。对于每种策略，有 8 名患者被转介，其中 5 名（63%）接受了 GCT。GP 实践的干预参与率为 A 策略的 31%（11 分之 36）和 B 策略的 46%（21 分之 46）。GP 将“相关性”和“可操作性”视为两种策略的促进因素，而对于 B 策略，技术障碍则阻碍了实施。
两种策略在初级保健中对卵巢癌幸存者进行 GCT 的病例发现的有效性和接受程度都很有前景，但在广泛实施之前还需要进行更大规模的研究。
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