Trial Information

GenetiKiT: Evaluation of the Impact of a Multifaceted Intervention to Enhance the Delivery of Genetics Services by Family Physicians.

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.