Abstract for presentation at 11th International Congress of Human Genetics

The GRAIDS Trial: a cluster-randomised controlled trial of computer support for the management of familial cancer in primary care

  • Prof Jon Emery, General Practice, University of Western Australia, Australia
  • Dr Helen Morris, General Practice & Primary Care Research Unit, University of Cambridge, United Kingdom
  • Prof Ann Louise Kinmonth, General Practice & Primary Care Research Unit, University of Cambridge, United Kingdom
  • Dr Toby Prevost, MRC Biostatistics Unit, University of Cambridge, United Kingdom
  • Mr Tom Fanshawe, Centre for Applied Medical Statistics, University of Cambridge, United Kingdom
  • Ms Becky Goodchild, General Practice & Primary Care Research Unit, University of Cambridge, United Kingdom
  • Prof Martin Bobrow, Department of Medical Genetics, University of Cambridge, United Kingdom

    • Introduction: Previous experimental studies have shown that computer support could improve the management of familial cancer by GPs. We report the results of the first cluster-randomised trial of computer support for the management of familial cancer in primary care.
    Methods: 45 general practices in Eastern England were randomised to the GRAIDS intervention or comparison arm. Comparison practices attended an educational session and received paper guidelines about familial breast and colorectal cancer. In intervention practices a lead clinician received brief training in cancer genetics and use of the GRAIDS software. The GRAIDS software is a simple pedigree-drawing program that implements clinical guidelines for familial breast and colorectal cancer and presents individualised information about breast cancer risk in a variety of formats.
    Results: The intervention led to significantly more referrals to the Familial Cancer Clinic; referrals from GRAIDS practices were more likely to be consistent with referral criteria (OR 3.4 p=0.02). Patients referred from GRAIDS practices had lower cancer worry scores at the point of referral (mean difference 1.44 p=0.02) but there were no differences in knowledge about familial cancer. Patients from the GRAIDS arm had more accurate risk perception but this failed to reach statistical significance. The intervention increased GPs’ confidence in managing familial cancer. GPs’ attitudes were generally positive about the GRAIDS intervention but there were concerns about prolonging consultations.
    Conclusions: The GRAIDS intervention resulted in increases in the number and quality of referrals to Familial Cancer Clinics with no adverse psychological effects in patients. This approach could have broader application to support the assessment of familial risk of common disease in primary care.

    Conference Organiser - ICMS Pty Ltd