August 16, 2007

Risky Business

The GRAIDS Trial: A Cluster Randomized Controlled Trial of Computer Decision Support for the Management of Familial Cancer Risk in Primary Care, published in the August 14, 2007 issue of the British Journal of Cancer, studied physicians’ use of family history risk assessment software in counselling patients. In this study, researchers in Australia and the UK used the software program, Genetic Risk Assessment on the Internet with Decision Support (GRAIDS). The research team randomized 45 group practices into two sets: one set was trained in the use of GRAIDS, which “links a user-friendly pedigree-drawing tool to patient-specific management advice regarding a family history of breast/ovarian and colorectal cancer, and provides additional numerical risk information about breast cancer.” The control group was trained in the current best practices for genetic referrals. Patients who were found to be at an increased risk in either set were referred to a regional genetics clinic. 

Outcomes were measured at practice, practitioner and patient levels. The trial found that the GRAIDS group both increased the number of genetic referrals, and ensured referrals more closely adhered to official referral guidelines. Additionally the GRAIDS group was able to identify more at-risk patients than the best practices group, and practitioners felt more confident in managing familial cancer. Positive patient outcomes were associated with GRAIDS usage as well; patients who were deemed at-risk in the GRAIDS group reported that they felt less anxious about their risk of cancer than compared to those patients in the best practices group. 

Genetics is increasingly important in clinical medicine, so it is no surprise that family history cancer screening software is being developed in countries throughout the world. For example, the study’s news release reports that Australian government is now funding a national electronic family history tool, based on GRAIDS software. In the United States, the CDC is developing its own software, Family Healthware, to help assess a patient’s genetic risk for coronary heart disease, stroke, diabetes, and colorectal, breast and ovarian cancers. The tool is currently being tested at three academic centers “to determine if personalized prevention messages tailored to familial risk will motivate people at risk to change lifestyle or screening behaviors.” Data collection is expected to be complete by the end of 2007. 

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