GenetiKiT: Evaluation of an Educational Intervention on the Delivery of Genetics Services by Family Physicians
Condition: Breast Neoplasm
MeSH terms: Breast Neoplasms
Study type: Interventional

Summary: 
      There is an urgent need for a knowledge translation strategy to facilitate the integration of
      genetics into family medicine, to improve the low knowledge base of most Canadian family
      physicians, ensure that the needs are met of those in the population who could benefit from
      genetic assessment, and facilitate evidence-based decision-making in the face of increasing
      patient demand.

      We have developed a multi-faceted intervention incorporating three distinct knowledge
      translation strategies: interactive educational sessions, a portfolio of tools for use in
      clinical practice and an innovative, efficient, information technology-based knowledge
      service designed to provide timely ("just-in-time") information which reflects both topical
      genetics issues and the pattern of users' queries (a so-called "push-pull" approach).

      We hypothesize that a multi-faceted knowledge translation intervention will improve the
      delivery of genetics services by family physicians.
    

Detailed description: 
      The intervention will be evaluated using a randomized controlled trial, in which family
      physicians will be allocated to receive the active or control interventions, with
      pre-intervention data collected 1 month prior, and post-intervention outcome data 6 months
      following the intervention.

      A list of practicing family physicians will be obtained from the chiefs of Family Medicine at
      local hospitals in Toronto, Ottawa, Timmins, and Thunder Bay. We will develop a sampling
      frame for each site reflecting the proportion of solo and group practitioners in the
      community. A statistician independent of the study will generate a random number sequence to
      allocate practitioners to the control or intervention groups. There is a potential danger of
      contamination if two family physicians are recruited from the same group practice and
      randomized to different study arms, therefore only one physician per practice will be invited
      to participate in the study. Once one family physician has been recruited from a practice,
      all other physicians from the same practice will be deleted from the sampling frame.

      Our intervention has three components: an interactive educational workshop, a portfolio of
      tools for family physicians to use in their day to day clinical practice, and a new IT-based
      knowledge service.

      The workshop will deal with practical medical genetics knowledge, risks, benefits and
      limitations of genetic testing including psychosocial risks, confidentiality and insurance
      issues as well as a critical appraisal framework by which to assess genetic tests. The
      workshop will be 60 minutes in length and offered at several times and dates to facilitate
      attendance. The College of Family Physicians of Canada educational credit of 1 hour is
      available for participation in this project.

      Several tools will be presented at the workshop:

      A) A family history tool B) Genetics Pearls C) Physician risk triage and management cards for
      familial cancer covering risk assessment and management of hereditary breast and colorectal
      cancer.

      D) A table outlining the possible consequences of genetic test results E) Patient information
      aids to help patients self-identify their risk of hereditary cancer F) GeneMessenger is
      designed primarily to address knowledge gaps about specific genetics issues in the news,
      about which family physicians may feel ill-equipped to form confident opinions. The research
      team will scan the mainstream print media for headlines or stories that relate to medical
      genetics discoveries or topics. Supported by a geneticist and an expert family physician, a
      genetic counselor will appraise the discoveries, tests or interventions for their relevance
      to family practice. She will prepare a definitive short review for participants within 1-2
      weeks, but, where appropriate and possible, will prepare a preliminary comment for rapid
      communication within 1-2 days. Communication will be by email or fax as chosen by the
      participant. Family physicians will be able to contact the service to suggest questions or
      topics they would like to see addressed. This service will not provide professional advice on
      specific cases or patients and referrals to genetics clinics would continue in the usual
      fashion. Physicians would be free to seek telephone advice from geneticists or counselors
      regarding specific patients but these would not be addressed as part of this service.

      Data will be collected one month before and six months after the intervention by postal
      survey to the participating physicians. Changes in intention to refer to genetics services in
      response to 10 clinical vignettes will be compared between the control and intervention
      group.
    

Intervention name(s): Multifaceted educational intervention
Intervention type(s): Behavioral
Intervention description(s): Educational materials available at end of study
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Keywords: Primary health care; Breast neoplasm; Education