General practitioners’ views on genomics, practice and education: A qualitative interview study

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Background and objectiveGenomics is moving rapidly into mainstream medicine through clinical genomic testing and consumer-initiated online DNA testing.The aim of this study was to identify Australian general practitioners' (GPs') views on genomics, impact on practice and educational needs to inform continuing education. MethodsSemi-structured interviews were conducted, with constant comparative inductive analysis and governance from a national taskforce. ResultsTwenty-eight GPs (43% female) were interviewed; 71% worked in a metropolitan workplace.Most initially reported little experience with genetic/genomic tests but, when prompted, recognised encountering genomics, mainly non-invasive prenatal and single-gene tests.Many GPs referred patients for cancer screening to genetic services or specialists.GPs reported needing continuing education and resources, with preferences underpinned by relevance to practice. DiscussionGPs are integrating genomic testing into care, mainly through prenatal screening, and anticipate further impact.They want diverse and context-dependent education but are unaware of some available resources, such as The Royal Australian College of General Practitioners' Genomics in general practice guideline.GENOMICS IS MOVING RAPIDLY into mainstream medicine, 1 and general practitioners (GPs) increasingly face decision making regarding clinical genomic testing and responding to the demands of consumer-driven (personal and/or online) DNA testing.Genomic testing, including partial or whole-genome sequencing that simultaneously looks for variants in up to 20,000 genes, brings new demands.There are significant challenges in incorporating genomics into medicine, including into general practice.GPs' lack of knowledge and skills have been reported as major barriers to integrating genetics into their practice in Australia, 2,3 the Netherlands, 4,5 the USA, [6][7][8] Canada, 9,10 Europe and the UK.11 Challenges identified by GPs in the literature that particularly relate to genetic (rather than genomic) testing include: a lack of confidence to carry out basic medical genetic tasks, 6,11,12 longer consultation times, 3,8,13 keeping up to date, 14 lack of evidence for tests, 2,8 and knowing who and how to refer to genetic services.2,7,9,10,15 Information about the education needs of GPs in genomics is limited.In Australia, studies to identify GPs' educational needs in genetics were mainly conducted prior to 2006.In a recent study on providing personal genomic risk information in Australia, GPs were open to the delivery of genomics in primary care, but most felt they were unprepared and had gaps in their knowledge.16

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