Session II: implications for clinical practice

1. Risk communication: introduction

Jonathan Gray

Consultant in Medical Genetics. University of Wales College of Medicine

To set the context for the session on dealing with risk in primary care, Dr Gray outlined the procedures adopted by the cancer genetics services in Wales. The advent of genetic testing in common cancers (breast, ovarian, and bowel) is driving growing demand for which primary care practitioners, surgeons, oncologists and gynaecologists alike require clear referral guidelines. Guidelines have been published as a result of an all-Wales multidisciplinary consensus group meeting and GP focus groups.

The model adopted in Wales is very much nurse-centred. All referrals are seen by a clinical nurse specialist, who carries out a risk assessment. The particular care pathway that a patient then experiences depends on that assessment, with “low risk” patients being referred back to primary care. The “low risk” group is the largest, and research is ongoing in Wales into how best to support primary care in their management of these patients.

Practical examples of family pedigrees leading to either a low, moderate or high risk assessment were discussed by Dr Gray. It was emphasised that confirming the family history, as first reported by a patient, is critical to an accurate assessment and therefore to the patient receiving the most appropriate care.