General practitioners, generalism and the new genetics : qualitative and quantitative studies of general practitioners' response to the implications of genetic advances in breast cancer for their roles

Abstract

Policy-makers, clinical geneticists and the Royal College of General Practitioners recognise general practitioners will identify patients with genetic susceptibility to common cancers. They recommend most patients' enquires about genetic susceptibility to common cancers, such as breast cancer, should be managed by general practitioners (GPs). Since the ratio of consultant geneticists to general practitioners is roughly 500 to one general practitioners will necessarily have a role. This research explores GPs' ideas of their role and their responses to roles identified for them by policy-makers and experts. I used qualitative and quantitative methods. Grounded theory guided open-ended interviews with a purposive sample of GPs. Interviews explored GPs' ideas, beliefs and experiences of genetic medicine in general, and more specifically, in relation to breast cancer. As data collection and analysis proceeded a theoretical sample (selection guided by the emerging analysis) was generated to explore categories further, and to test the integrity and credibility of the emerging analysis. Two core themes were identified: 1) genetics in the generalist context, which included appropriate generalist intervention, the ethical dilemmas implicit in the therapeutic gap and the familial-hereditary distinction in primary care, and 2) the implications for the generalist identity, including the potential marginalisation of generalism. The category familial-hereditary distinction was used to construct a hypothesis and a questionnaire which was applied to a random sample of 200 GPs in the Wessex area. A descriptive statistical analysis and factor analysis of the questionnaire data supported the findings of the qualitative study. Both studies revealed inconsistencies between policy-makers' and GPs' definitions of general practitioners' role in implementing genetic advances. General practitioners' emphasised the need to build on current practice, whereas policy-makers focused on transforming practice to include new and specialised roles.

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