Increasing confidence and changing behaviors in primary care providers engaged in genetic counselling.
Increasing confidence and changing behaviors in primary care providers engaged in genetic counselling.
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DOI：
10.1186/s12909-017-0982-4
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发表时间：
2017-09-13
影响因子：
3.6
通讯作者：
Green MJ
中科院分区：
文献类型：
--
作者：
Wilkes MS;Day FC;Fancher TL;McDermott H;Lehman E;Bell RA;Green MJ
筛查和咨询遗传条件是初级保健实践中越来越重要的一部分，特别是考虑到美国缺乏遗传咨询师。然而，初级保健医生（PCP）往往有一个基于证据的筛选，沟通的方法，鼓励共同决策，伦理，法律的，和社会影响（ELSI）的问题有关的基因突变筛查的理解不足;和临床遗传学的基础知识。本研究探讨了一个互动的，基于网络的遗传学课程，针对PCP在非学术初级保健设置是上级在改变实践知识，态度和行为相比，传统的教育方法，特别是在讨论常见的遗传条件。将加州和宾夕法尼亚州的121名PCP随机分为干预组（IG）或对照组（CG）。IG医生完成了一个6小时的互动式网络课程，涵盖沟通技巧，基因检测，风险评估，ELSI问题和实践行为的基础知识。CG医生提供了传统的继续医学教育（CME）方法（临床综述文章），提供了等同的信息。与对照组相比，干预组的PCP在知识方面表现出更大的增长。与接受传统CME材料的人相比，干预PCP对教育材料也更满意，对他们的遗传学知识和技能更有信心。干预PCP认为，基于网络的课程涵盖医疗管理，遗传学和ELSI问题显着优于对照组，并与传统的课程相比。干预组认为在线工具提供了几个优势，并与标准化患者更好地共享决策，然而，在PCP和患者之间ELSI讨论的增加方面，两组之间的行为变化没有差异。虽然我们的干预被认为是更愉快的，表现出显着的事实学习和保留，并增加了共享决策的做法，有几个不同的行为变化周围ELSI讨论。不幸的是，在临床遗传学中实施行为改变的障碍并不是我们干预所独有的。也许缺少的元素是，忙碌的医生需要系统级的支持，以参与围绕遗传学问题的有意义的讨论。促进医生和患者之间积极参与的下一步可能是为PCP提供所需的工具，以便他们在护理点轻松获取所需的材料，以参与围绕临床遗传学的联合讨论。
Screening and counseling for genetic conditions is an increasingly important part of primary care practice, particularly given the paucity of genetic counselors in the United States. However, primary care physicians (PCPs) often have an inadequate understanding of evidence-based screening; communication approaches that encourage shared decision-making; ethical, legal, and social implication (ELSI) issues related to screening for genetic mutations; and the basics of clinical genetics. This study explored whether an interactive, web-based genetics curriculum directed at PCPs in non-academic primary care settings was superior at changing practice knowledge, attitudes, and behaviors when compared to a traditional educational approach, particularly when discussing common genetic conditions. One hundred twenty one PCPs in California and Pennsylvania physician practices were randomized to either an Intervention Group (IG) or Control Group (CG). IG physicians completed a 6 h interactive web-based curriculum covering communication skills, basics of genetic testing, risk assessment, ELSI issues and practice behaviors. CG physicians were provided with a traditional approach to Continuing Medical Education (CME) (clinical review articles) offering equivalent information. PCPs in the Intervention Group showed greater increases in knowledge compared to the Control Group. Intervention PCPs were also more satisfied with the educational materials, and more confident in their genetics knowledge and skills compared to those receiving traditional CME materials. Intervention PCPs felt that the web-based curriculum covered medical management, genetics, and ELSI issues significantly better than did the Control Group, and in comparison with traditional curricula. The Intervention Group felt the online tools offered several advantages, and engaged in better shared decision making with standardized patients, however, there was no difference in behavior change between groups with regard to increases in ELSI discussions between PCPs and patients. While our intervention was deemed more enjoyable, demonstrated significant factual learning and retention, and increased shared decision making practices, there were few differences in behavior changes around ELSI discussions. Unfortunately, barriers to implementing behavior change in clinical genetics is not unique to our intervention. Perhaps the missing element is that busy physicians need systems-level support to engage in meaningful discussions around genetics issues. The next step in promoting active engagement between doctors and patients may be to put into place the tools needed for PCPs to easily access the materials they need at the point-of-care to engage in joint discussions around clinical genetics.
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影响因子：
5.5
作者：
Bellcross, Cecelia A.;Kolor, Katherine;Khoury, Muin J.
通讯作者：
Khoury, Muin J.
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5.7
作者：
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通讯作者：
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影响因子：
120.7
作者：
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通讯作者：
Manger, DT