Table 3 Included studies

Bethea et al. (2008) [24]

United Kingdom.

Funding; UK Department of Health and NHS R&D.

To determine the current level of competence and confidence of primary care professionals in relation to management of familial cancers and explore how these were affected by educational outreach.

Quasi-experimental design.

Longitudinal interventional study using matched groups.

Baseline cross-sectional survey preceded the study.

Follow-up data were collected six months after the completion of the intervention.

GPs and practice nurses from both rural and urban areas of England.

217 practitioners completed both pre and post intervention surveys: 29 from intervention group, 188 from non-intervention group.

Genetics educational outreach comprising two sessions on familial cancer and one on other genetic conditions (details reported in another paper [36])

Descriptive statistics to analyse data on confidence and competence. Logistic regression analysis to identify differences between ntervention and non-intervention groups.

Respondents from intervention practices more confident in risk assessment for breast cancer (OR 2.50, p = 0.03, 95 % CI 1.10–5.67) and in knowing family history to collect (OR 2.39, p = 0.02 95 % CI 1.14–5.00), make a risk assessment (OR 3.65, p = 0.01, 95 % CI 1.38–9.61)) and reassurance of low risk patients (OR 3.94,p = 0.01, 95 % CI 1.39–11.22) in relation to bowel cancer.

Knowledge was improved in relation to correct assignation of breast cancer in the intervention group (X ² = 4.37,df = 1, p = 0.04)

81 %

Blinding of investigators not mentioned.

Low response in pre- and post- intervention surveys from intervention group.

Carroll et al. (2009) [25]

Canada.

Funding; Ontario Womens’ Health Council.

‘To increase primary care providers’ awareness and knowledge of genetic issues and genetic services, as well as their confidence in dealing with genetic issues and use of resources.’

Quasi-experimental design. Longitudinal study using a survey pre-course (T1) and six months after the course (T3). Satisfaction with the programme was assessed immediately after the study day (T2).

Workshop attended by 29 primary care professionals but responses to survey from only 21(67 % were family physicians).

One day workshop for primary care professionals. Educational materials (powerpoint presentations) available after the workshop on the web.

Descriptive statistics. McNemar test and Wilcoxon signed rank test used to assess changes in knowledge and confidence between T1 and T3.

Self- assessed confidence in skills related to managing adult-onset conditions increased from pre-course mean score of 2.3 of a possible score of 5 (SD = 0.7) to post-course mean scores of 3.0 (SD = 0.9), (p = 0.005).

Self- assessed confidence in skills related to prenatal genetics did not increase: the mean score pre-course was 3.4 (SD = 1.1) and post score was 3.6 (SD = 1.1). Knowledge increased regarding hereditary colorectal cancer: 5/21 attendees answered correctly pre-course, compared to 10/20 post course (p = 0.031).

72 %

Research question and study design not well elucidated.

Small sample no indication of required size.

Carroll et al. (2011) [26]

Canada.

Funding: Canadian Institutes of Health Research.

Evaluation of an educational intervention

Randomised controlled trial comparing family practitioners who received the intervention with those who did not.

Pre-intervention data collected one month before intervention and post-data six months after intervention.

Family practitioners from a range of practices in Canada: 47 in intervention group and 33 in control group.

60 min workshop, portfolio of practical tools and knowledge support service

Analysis of covariance used to compare results in the two groups.

Those in intervention group scored more highly for confidence regarding referral decisions after the intervention. The adjusted mean score of the intervention group was 47.0 (95 % CI 44.9–49.2), compared with 37.9 (95 % CI 35.1–40.7) in the control group. They were more likely to make appropriate referral decisions with an adjusted mean of 7.8 (95 % CI = 7.4–8.2) in the intervention group, compared with mean of 6.4 (95 % CI = 5.8–6.9 in control group. The intervention group scored more highly on post-intervention knowledge questions, differences in knowledge scores between control and intervention groups indicated an odds ratio of 2.56 (95 % CI 0.90–7.31) for knowledge of the likelihood of a patient having a BRCA mutation, 1.43 (95 % CI 0.31–6.52) for percentage of women with breast cancer with a BRCA mutation and 1.23 (95 % CI 0.46–3.28) of number of patients with genetic predisposition to colorectal cancer who will develop the disease.

96 %

Sample size small compared to that required to provide 80 % power to detect difference of 0.5 of a SD.

Clyman et al. (2007) [27]

USA.

Funding: US Department of Health and Human Services.

To assess the utility of an educational programme in medical genetics

Quasi-experimental design. Pre and post intervention survey.

Knowledge tested immediately after each lecture.

36 GPs who had not had genetic education beyond basic medical training.

8 × 60 min lectures over 2 years and monthly 45 min seminars for two years.

Descriptive statistics and paired Student t-test.

There was an improvement in knowledge after the intervention, with mean pre-intervention score of 61.95 (SD 19.1, 95 % CI 58.8–65.1), compared with post-intervention scores of 76.1 % (SD 16.8, 95 % CI 73.3–78.9, 9), (p < 1×10⁻¹⁰).

70 %

Sample small and analysis based on pre and post test score for each participant for each of 8 lectures to higher numbers.

Emery et al. (2007) [28]

United Kingdom.

Funding: Cancer Research UK and NHS R&D Support for Science.

Assessment of use of risk assessment software in conjunction with education.

Randomised controlled trial.

Follow-up 12 months after intervention introduced.

45 practice teams – 23 in intervention group and 22 in control group.

45 min training session on cancer genetics. Lead clinicians for the research in each practice attended an additional 90 min session on using the software.

Use of software analysed using t-test.

Linear mixed-effects models used to analyse referral appropriateness.

In intervention practices mean number of referrals was 6.2 (SD 3.1) per 10,000 registered patients per year, compared to a mean of 3.2 (SD 2.8) in control practices. The odds ratio of intervention vs control practices in referring patients in accordance with referral guidelines was 5.2 (95 % CI 1.7–15.8) and referred patients were more likely to have an increased risk of cancer when assessed by the genetic service (OR 0.7, 95 % CI 0.3–1.5

96 %

Incomplete control of confounding variables.

Houwink et al. (2014) [30] Netherlands.

Funding: Netherlands Genomics Initiative.

To determine whether primary care practitioners’ genetic knowledge improved longer term through an oncogenetics training programme.

A blinded, randomized controlled trial (RCT) comparing an intervention group (received education) and control group.

Follow-up occurred six months after training.

80 Dutch GPs working in family practice: 40 in intervention group and 40 in control group. 24 from intervention group and 20 from control group completed the study

2 h online genetics education course.

Mean (test scores) and regression analysis.

More precise estimations

of knowledge gained were obtained by the regression analysis. The effect of the intervention was found to be statistically significant, amounting to 0.055 on the proportion correct scale; the corresponding value for the standardized regression coefficient was

.27, indicating an almost moderate effect size at T1. This value further increased 6 months after the intervention (.34, moderate effect size).

Global score for satisfaction was 7.9/10 (SD 1.3, 95 % CI 7.5–8.3) while applicability scores were more diverse neutral scores for recognition of disease, referral to a specialist and knowledge of possibilities/limitations of genetic testing (2.7–2.9). The scores for increased knowledge about genetic diseases and basic genetic concepts were 3.3–3.8.

84 %

Small sample size due to large attrition rate.

Houwink et al. (2014) [29] Netherlands.

Funding: Netherlands Genomics Initiative.

To determine whether primary care practitioners’ genetic skills improved through an oncogenetics training programme.

A blinded, randomized controlled trial (RCT) comparing an intervention group (received education) and control group.

Follow-up occurred three months after training.

56 (38 in intervention group, 18 in control group) GPs from two Dutch provinces.

4 h face to face training in oncogenetics.

Descriptive statistics and regression analysis.

Between group differences were found to be nonsignificant for the pretest (T0) and retention (T2) test, but the posttest (T1) difference of 0.19 in favor of the intervention group was found to be significant (t-test; p < 0.0005).

Standardised regression coefficient for the effect of the training on skills was .34 at T1 (95 % CI .05–.23) one month after the training and .28 at T2 (95 % CI .03–.20) two months later, both indicating moderate effect size. Performance improvement in the intervention group at T2 was 80 % of the immediate effect at T1. Mean satisfaction and self-reported applicability scores were combined 7.7/10, SD 1.9, 95 % CI 6.7–8.6).

77 %

High number of non-responders, high attrition rate, especially in control group.

Laberge et al. (2009) [31] US.

Funding:

Maternal and Child Health Bureau of the Health resources and Services Administration.

To evaluate the long term impact of the Genetics in Primary Care Project, a genetics educational programme to prepare primary care physicians for practice.

Qualitative descriptive study based on content analysis. Data collected during site visits or telephone to interview teachers.

Follow-up period not exacty specified, but 3–4 years after completion of the programme.

Teams from 20 institutions.

Genetics in Primary Care Project programme included: 1) “train the trainer” workshops and (2) informal teaching in the medical school/residency curricula.

Content analysis.

75 %

Little background connecting to theoretical framework or body of knowledge.

Interviews described but content of site visits not clear.

Metcalfe et al. (2005) [32]

Australia.

Funding: no stated funding source.

To determine the effects of an educational intervention on GP knowledge of prenatal tests.

Quasi-experimental design.

Single group pre-test and repeated post-test design.

Questionnaire administered pre-workshop, post-workshop and 6–8 months later.

111 GPs who attended one of three workshops on prenatal testing. All provided antenatal care.

One face to face educational workshop based on two prenatal cases.

Frequencies and means. Student t-test to compare differences in means. Independent samples t-tests for comparisons between groups.

ANOVA to identify factors influencing scores.

Number of GPs feeling quite or very confident about prenatal screening increased significantly (p < 0.01) from 15.9 % pre-workshop to 81.9 % post workshop and 45.1 % 6-8 months later. Knowledge of prenatal screening and testing was significantly improved from a mean of 51.2 % (SD 1.59, 95 % CI 48.02-54.39) pre intervention to 62.88 % (SD 1.51, 95 % CI 59.86-65.89) post workshop and 58.92 % (SD 1.6, 95 % CI 55.71–62.12) at follow up.

95 %

Confidence was self-reported measure.

Srinivasan et al. (2011) [33]

US.

Funding: National Human Genome Research Institute.

To evaluate a web-based progamme on ELSI issues in genetics for primary care residents

Quasi-experimental design. Longitudinal study, using pre and post course surveys that covered prior experience, self-efficacy and knowledge of genetics.

Follow-up data collected after completion of the curriculum (exact period of time not given).

210 primary care residents in paediatrics, internal medicine or family medicine, all were enrolled at one of three institutions.

Web-based educational programme based on ten cases and five tutorials. Each participant studied five cases and two tutorials.

Changes in self-efficacy and knowledge were analysed using the t-test. Anova was used to compare levels of experience in genetics between specialties.

Descriptive statistics for non-parametric values.

Mean pre-test knowledge scores were 9.6/14, compared with post scores of 10/14.

Overall self-efficacy increased from pre-course mean of 71.2 to post-course mean of 83.4.

73 %

Little description of sample demographics. In two centres, the course was mandatory, which will have influenced uptake.

Wilson et al. (2006) [34]

UK.

Funding: NHS R7D Health Technology Assessment Programme.

To determine if GP confidence in managing patients with a family history of breast cancer was altered by use of educational session and a condition-specific software tool.

Pragmatic cluster randomised controlled trial.

Intervention arm received software and training. Follow-up data were collected at the end of the one year intervention period.

GPs working in specific practices in a region in Scotland. Practices were assigned to either the control or intervention groups.

Software on CD-ROM was sent to each practice in intervention group. GPs in those groups were sent an individual letter about the study and invited to one educational session on use of software. Only 11.9 % of GPs in intervention group attended an educational session.

Chi-square tests, intracluster relation coefficient.

No significant differences reported between intervention and control groups in changes in GP confidence in managing patients, referral patterns, or initial patient risk assessment.

96 %

Confidence in managing patients was self-reported measure.