Background
Methods
Conceptual framework
Study design
Key Questions | Probes |
---|---|
Attitudes and perception 1. What do you understand about GSa? How relevant is GS to your patient population? | • How have you learned about GS? • How prepared are you to counsel patients or discuss GS? (If unprepared, explain why not) |
Experience 2. What is a typical day in your clinic? What guides you to screen patients in your practice? | • What GS have you recommended? • (If with experience) Please share your patient experience with GS |
Adoption in clinical practice 3. What challenges do you face, or anticipate facing, with adopting GS in your clinical practice? | • What do you think would motivate you to prepare for these challenges? • What are the pros/cons of GS for you and your patients? |
Informational and infrastructural needs 4. How would you like to be supported when using/adopting GS in your clinical practice? | • What information about GS would be helpful? • How would you like to learn more about GS? |
Study setting
Data collection
Data analysis
Results
Participants
Characteristic | Private-practice, 15 (%) | Public-employed, 15 (%) |
---|---|---|
Gender | ||
Male | 9 (60%) | 7 (47%) |
Female | 6 (40%) | 8 (53%) |
Ethnicity | ||
Chinese | 12 (80%) | 13 (87%) |
Indian | 2 (13%) | 0 (0%) |
Others | 1 (7%) | 2 (13%) |
Practice experience (years) | ||
5–10 | 5 (33%) | 8 (53%) |
11–15 | 2 (14%) | 5 (33%) |
16–20 | 3 (20%) | 1 (7%) |
> 20 | 5 (33%) | 1 (7%) |
Age (years) | ||
30–39 | 7 (47%) | 12 (80%) |
40–49 | 3 (20%) | 2 (13%) |
> 49 | 5 (33%) | 1 (7%) |
Average number of patients seen per day | ||
< 20 | 0 (0%) | 1 (7%) |
20–40 | 5 (33%) | 4 (26%) |
> 40 | 10 (67%) | 10 (67%) |
Qualifications | ||
Master FMa training | 10 (67%) | 15 (100%) |
Advanced FM training | 4 (26%) | 5 (33%) |
Common themes
Personal lack of training and experience
“It is not in our training, not covered in medical school. In my post-grad training, I have never been educated on this.” Public14“Not much is known (to FPs) about genetic screening, the facilities available, where to go for testing, knowledge about the diseases, and counselling. You need all those factors before you can manage patients.” Private12
“I don’t think we would have the experience. If you see these cases once every few months, then…we cannot offer the same standard of care as a specialist.” Public14
Roles and relevance of genetic screening
“(In)…familial hyperlipidaemia,…there is a huge implication on the patient as well as their family members but right now we cannot confirm that (without genetic testing)…Other things would be HLA testing,…thalassemia and Down’s syndrome…” Public10
“…the principles of family medicine are to…(provide)…comprehensive care,…so definitely genetic testing should be included…we know the patients…best,…and sometimes we have relationships with their family members.” Public11“I think that the FP would be a very good person for these kinds of genetic conditions. People that come to see me are living nearby. So even if their family does not regularly see me, they (live) nearby and can always bring the family if the need arises.” Private14
“specialists should be the ones who do the (GS)…what we in primary care can do is…to be aware, or need to be educated…so that when patient come and ask us, we can actually advise.” Public3
Reluctance and resistance
“If the (test result) is positive it is like opening a can of worms. (The patient) might not be able to handle it and that is one of the reasons a physician might not want to take on this…” Public15
“I rarely recommend, because it’s not the standard of care, not a compulsory thing …maybe once in a while, I’ll see a neurofibromatosis patient and then I’ll refer them but that’s really rare.” Public5“I think there is limited scope for GS in primary care in terms of the spectrum of patients and the main chronic diseases that we manage…there may be a certain role for GS in a very, very small group.” Public14
FP motivations for adoption of GS
“So it depends on the interests also of the doctor, so some want to go further, draw genograms…and then advise the family.” Private11“Best is to have a dedicated clinic just to run this kind of (GS).” Public 12
“…if the cost is okay,…the test is reliable and…able to provide us with more information to better the preventative health of the patient, then it will be good.” Public13“If there are clear guidelines from the government and they can come up with some financial support that would help. Also if all health practitioners are on board, including the specialists, then the patients are more likely to be convinced to do this genetic testing” Private14
Patient factors as barrier
“I have faced difficulties getting patients to even go for their routine screening...patients are not keen to test as they don’t want to worry or they just want to live their life happily.” Public9“…you are making a person worry over a onset of a disease that has not taken place yet…by giving a label, you are making a person into a patient…ethically, do we wish to put a kind of mental burden onto a person?” Private11
Potential solutions for implementing GS
“ongoing information support would be useful…CME talks, brochures, or pamphlets…to remind FPs.” Public15“(We need) guidelines…followed up with interactive teaching, workshops and lectures.” Private12“…a template in-built into our IT system…where we can assess risk based on family history…help us identify patients who may benefit from (GS).” Public8
“what we lack is coordination…coordination takes time, effort, expertise and relationships…” Private5
“…if you raise the status and there is formal recognition, then I think it’s more appealing…FPs can feel more supported (and) more confident in offering this.” Public7
Unique themes: private-practice
Strong longitudinal patient relationship
“the (private) FP, plays a huge part because we have the privilege of…see(ing) patients from cradle to grave.” Private13
Practice autonomy
“If (GS) is easy to utilise, it would be a factor in whether we use the test, besides the cost and demand…the ease of use…would be a major factor.” Private12
Higher patient literacy
“We are beginning to see young patients less than forty (years old), they are more educated…more willing to test…often driven by fear. So on one hand they want to test but on the other hand they are also worried about the results. I need to be quite careful in counselling them.” Private2
Unique themes: public-employed
Lack of control
“we still need to see acute cases, chronic disease management which is our bread and butter…There’re a lot of healthcare initiatives and projects that primary care is involved in. With all these, time constraint is the big challenge” Public11
“….in the public sector, many patients don’t have a fixed doctor…If you see a different doctor each time, it’s very hard (for FPs to offer GS).” Public9
Lower patient socioeconomic status and literacy
“If the FP assesses that the patient is not capable or does not have the intellectual understanding of what genetic testing is, they might not want to offer GS...(the) FP might not want to deal with, or explain it to the patient.” Public15
Rigid administrative infrastructure
“I think (GS) is quite a new field and senior administrators are not aware. That’s the reason why it’s not being pushed out to the public clinics.” Public1“The leaders…the policy makers…We need their support…without them, we cannot do anything.” Public6